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Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Commonwealth of Massachusetts File with: City or Town Clerk or Flection Commission Fill in Reporting Period dates: Beginning Date: 01/01/2099 Ending Date: 12!31!2019 Type of Report: (Check one) ❑ 8th day preceding preliminary [] 8th day preceding election ❑ 30 day after election year-end report ❑ dissolution Jill 1.Hai Jill Hai for Selectman Candidate Full Name(if applicable) Committee Name Selectman Jodi R.Galin Office Sought and District Name of Committee Treasurer 6 Highland Avenue,Lexington,MA 02421 5 Fletcher Avenue,Lexington,MA 02420 Residential Address Committee Mailing Address Telephone Number(optional): 7818623766 Telephone Number(optional): 7819104681 SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report 865.84 Line 2: Total receipts this period(page 3, line 11) 01 Line 3: Subtotal (line 1 plus line 2) F 865.84 Line 4: Total expenditures this period(page 5, line 14) 105.33 Line 5: Ending Balance(line 3 minus line 4) 0.54 Line 6: Total in-kind contributions this period(page 6) Line 7: Total(all)outstanding liabilities(page 7) lv � Line 8: Name of bank(s)used: Citizens Bank 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 this reporting period and represents the campaign finance activity of all persons acting under the a rity orlon beh if o this mmittee 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: k6kidavit of Candidate:(check i box only) Candidate with Committee and no activity independent of the committee 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,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 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 contributions,loans receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents the campaign finance activity of ail persons acti g.under the authority or on behal committee in accordance with the requirements of M.G.L,c.55. Signed under the penalties of perjury: /f (Candidate's signature) Date: [ ( �