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Form CPF M 102: Campaign Finance Rcport <br /> Municipal F®r <br /> Office of Campaign and Political Finance <br /> Commonwealth <br /> of Massachusetts <br /> File with: City or Town Clerk or Election Commission <br /> Fill in Reporting period Cates: Beginning Date: 01/01/2021 Ending Date: 02/08/2021 <br /> Type of Report: (Check one) <br /> ® 8th day preceding preliminary R 8th day preceding election ® 30 day after election ® year-end report ® dissolution <br /> Ji€€ 1. Hai Ji€l Hai for Lexington <br /> Candidate Full Name(if applicable) Committee Name <br /> Select BoardJodi R. Galin <br /> Office Sought and District Name of Committee Treasurer <br /> 6 Highland Avenue, Lexington, MA 02421 5 Raymond Street, Lexington, MA 02421 <br /> Residential Address Committee Mailing Address <br /> Telephone Number(optional): 7818623766 Telephone Number(optional): 7819104681 <br /> SUMMARY BALANCE INFORMATION: <br /> 660.72 <br /> Line 1: Ending Balance from previous report <br /> Line 2: Total receipts this period(page 3, line 11) 7,70, <br /> Line 3: Subtotal (Iine 1 plus line 2) 660.7r <br /> Line 4: Total expenditures this period (page 5, line 14) ` <br /> K0.7 ` i1 <br /> Line 5: Ending Balance(line 3 minus line 4) rk <br /> l T1- <br /> Line 6: Total in-kind contributions this period (page 6) 0 <br /> Line 7: Total(all) outstanding liabilities (page 7) <br /> Line 8: Name of bank(s)used: Citizens Banc <br /> Affidavit of Cummittee Treasurer: <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 a€l campaign finance <br /> activity,including all contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents the campaign <br /> finance activity of all persons acting under the authority or on be If of hisommittee in accordance with the requirements of M.G.L.c.55. <br /> Signed under the penalties of perjury: ` (Treasurer's signature) Date: C) o C6 <br /> FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(cheep I box only) <br /> Candidate with Committee and no activity independent of the committee <br /> 1 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 <br /> activity,of all persons acting tinder 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, <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 /> ❑ l certify that I have examined this report including attached schedules and it is,to the best of my know[edge and belief,a true and complete statement of all 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 perso t actingunder the au ori[ 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: ' �' r ' <br /> T <br />