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Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Commonwealth of Massaclmsetts Fite with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: EndingDate: f f Type of Report: (Check one) [] 8th day preceding preliminary 8th day preceding election [� 30 day after election ❑ year-end report ❑ dissolution Candidate Full Name(if applicable) Committee Name Office Sought and istrict Name of Committee Treasurer Residential Address Committee Mailing Address Telephone Number(optional): Telephone Number(optional): SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period(page 3,lune 11) ✓' Line 3: Subtotal(line i plus line 2) ' Line 4: Total expenditures this period(page 5, line 14) — e Line 5: Ending Balance(line 3 minus line 4) r Lime 6: Total in-kind contributions this period(page 6) C7) .` r1_1 _V1 C—j Line 7: Total(all)outstanding liabilities(page 7) Line$: Name of bank(s)used: CD Affidavit of Committee Treasurer; I certify that I have examined this report including attached schedules and it is,to the best of my knowledge and belief,a true and complete statement of all campaign finance activity,including all contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for Ibis reporting period and represents the campaign finance activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L,C.55. Signed under the penalties of perjury.- (Treasurer's signature) Date: FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(check 1 box only) Candidate with Committee and no activity independent of the committee ❑ I certify that I have examined this repott including attached schedules and it is,to the best of my knowledge and belief,a true and complete statement of all campaign finance activity,of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L.c.55. I have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Candidate without Committee OR Candidate with independent activity filing separate report I certify that I have examined this report inchrding attached schedules and it is,to the best of my knowledge and belief,a true and complete statement of alt campaign finance activity,including contributions,loans,_receipts,expen res,disbursements,in-kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting udder the a� iont r on behalf of this committee iu &ordance with the requirements of M.G.L.c.55_ r Signed under the penalties of perjury: !` (Candidate's signature) Date: