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s <br /> Form CPF M 102: Campaign Finance Report <br /> Municipal For <br /> Office of Campaign and Political finance <br /> Coutniomvealth <br /> of Massachusetts <br /> Pile with: City or Tcnvu Clerk or Election Commission <br /> Fill in Reporting Period dates: Beginning Date: p l Q Ending Date: I z 3 t <br /> Type of Report: (Check one) <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after electionyear-end report ❑ dissolution <br /> � CL _ wALk-rn <br /> Candidate Pull Name(if applicable) Committee Name <br /> i o a c1s6 G Q tRc: � �c <br /> Office Sought and District Name of Committee'treasurer <br /> L;4 2 0 T lr 4EY14 o <br /> Residential Address <br /> Couttntittee Mailing Address <br /> Telephone Number(optional): — — cry Telephone Number(optional): <br /> _ �..CTv _ <br /> SUMMARY BALANCE INFORMATION: <br /> Line 1: Ending Balance from previous report <br /> Line 2: Total receipts this period (page 3,line 11) <br /> Line 3: Subtotal (line 1 plus line 2) <br /> Line 4: Total expenditures this period (page 5,line 14) <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: <br /> Affidavit.of Committee Treasurer: <br /> I certify that l 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,including all contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents die campaign <br /> finance activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of IbI.G.L.c.55. <br /> Signed under the penalties of perjury: (T'reasurer's signature) Date: <br /> FOR CANDIDATE TIL G Y: Affidavit of Candidate:(check 1 box only) <br /> C did ate with Committee and no activity independent of the committee <br /> certify that T 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 colder 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 1 have exaunincd this report including attached schedules and it is,to tine best of my knowledge and belief,a true and complete statement o€all campaign <br /> finance activity,including contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period acid represents the <br /> campaign finance activity of all persons acting under the authority or on behalf of tl>s committee <br /> ein(yaccordance with the requirements of M.G.L.c.55. <br /> a b ^r 4 <br /> Signed ander the penalties of perjury: `-`��"'�"'�-- (Candidate's signature) Date: <br />