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Form CPF M 102: Campaign Finance Report <br /> Municipal Form <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 dates: Beginning Date: ��% _ Ending Bate: . <br /> Type of Report. (Check one) <br /> r <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ear-end report ❑ dissolution <br /> i..?s'„ <br /> Candidate Full Name(if applicable) Committee Name ? <br /> piiice Sought and District Name of Committee Treasurer <br /> Residential Address Committee Mailing Addrdss <br /> Telephone Number(optional): Telephone Number(optional): <br /> SUMMARY BALANCE INFORMATION: <br /> Line 1: Ending Balance from previous report <br /> Line 2: Total receipts this period(page 3, line 11) ,wi. <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) � ` t <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 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,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 behalf of this committee in accordance with the requirements of M.G.L.c.55. <br /> Signed under the penalties of perjury: - -. (Treasurees signature) Date: L <br /> FOR CANDIDATE[+ILINCS ONLY: Affidavit of Candidate:(check 1 box only) <br /> Candidate with Committee and no activity independent of the committee <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 all campaign finance <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. I have not received any contributions, <br /> incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br /> Cli didate without Committee OR Candidate with independent activity fling separate report <br /> F-Ildcertify 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 <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 half of this committee in accordance with the requirements of M.G.L.c.55. <br /> Signed under the penalties or perjury: �_.,.- -. (Candidate's signature) Date: ft2 115�'4_Al <br />