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Form CPF M 102-0: Campaign Finance Report <br />Municipal Form <br />weave Office of Campaign and Political Finance <br />of Massachusetts <br />Fj): (tU ��ON <br />City or Town of: Pfease print or type all information, except signatures. <br />�, <br />Period: Beginning: <br />Ending: 12131 1 U <br />Type of Report (Check One) <br />8th day preceding preliminary/primary 8th day preceding election ❑ 30th day following election (town or special)0th day of January (Year -End report) <br />Pursuant to M.G.L. Chapter 55: <br />1. I certify that I am a candidate for or currently hold Municipal Office. <br />2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this reporting period, and do not have a campaign fund in existence. <br />3. I certify that I do not have a political committee. <br />SIGNATURE RESIDENTIAL ADDRESS <br />DATE PRINT NAME Si ed under the penalties of perjury (Street and Number) OFFICE SOUGHT <br />—I <br />w <br />I $roi I Y in o I /�i�W <br />0 <br />F <br />F <br />TIT <br />�`' -t <br />