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i <br /> 1 <br /> Form CPF M :1.024 Campaign Finance Report <br /> Municipal Form <br /> Office of Campaign and Political Finance <br /> �. <br /> Commonwealth <br /> ofMassachnsetts <br /> Pile with: City or Town Yerk or Election Commis ion <br /> Fill in Reporting Period dates: Beginning Date: p Z p�a Ending Date: / 3j L,air <br /> Type of Report: (Check one) <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election [year-end report ❑ dissolution <br /> r� T 6 A/ T- 1)6lCi;e1 r S,�-H,30L 67m <br /> Candidate Full Name(if applicable) Committee Name <br /> Office Sought and District Name orCommittee Treasurer <br /> S"!r1/DD - l�XinlGrr�r�/ rrT/� a Z �/0.� r+�.r€��+� �`�: •r,�/� L t�„ h f k vz�r <br /> Residential Address Committee Mailing Address <br /> Telephone Number(optional): Telephone Number(optional): <br /> SUMMARY BALANCE INFORMATION: <br /> Line 1: Ending Balance from previous report 12 . 6 g <br /> Line 2: Total receipts this period(page 3,line 11) <br /> Line 3: Subtotal(line I plus line 2) <br /> Line 4: Total expenditures this period(page 5,line 14) j 2.C�o <br /> Line 5: Ending Balance(line 3 minus line 4) <br /> Line 6: Total in-kind contributions this period(page 6) <br /> Line 7: Total(all)outstanding liabilities(page 7) <br /> Line 8: Name of bank(s)used: C G L�3��fC } Girth, 0 A <br /> Affidavit orCommittee Treasurer: �- <br /> I certify that T have examined this repo including attached s�h�les and it is,to the best ormy knowledge and belief,a true and complete statement of all campaign finance <br /> activity,including all contributions,loa s,receipts,expenditures,Zli bursements,in-kind contributions and liabilities for this reporting period and represents the campaign <br /> finance activity of all persons acting on cr the authority or- n Calf r this committee in accordance with the requirements of M.G.L,c.55. <br /> Signed under the penalties or perjury: �- — i (Treasurer's signature) Date: <br /> FOR CANDIDATE FILINGS ONLY.`Aittdavit of Candidate:(check I box only) <br /> C didate with Committee and no activity independent of the committee <br /> eertZ 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£mance <br /> =' 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. 1 have not received any contributions, <br /> incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br /> Candidate without Committee OR Candidate with independent activity filing separate report <br /> 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 al I campaign <br /> ❑ finance activity,including contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents the <br /> 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. <br /> Signed under the penalties of perjury: (Candidate's signature) Date: V/6 . <br />