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a <br />Form CPF M 102 -0: Campaign Finance Report' <br />Municipal Form 12 A } T + U <br />Office of Campaign and Political Finance <br />Commonwealth f <br />or Manacdutetts g <br />City or .Town of: <br />Please print or type all information, except signatures. <br />Fill in dates: Month <br />Day Year Month <br />Day <br />Year <br />Reporting Period Beginning <br />r € Ending 12 <br />d 1 4- L Ot `,C —R At � � A AL- <br />Type of Report: (Check One) <br />8th day preceding C 8th day preceding election ❑ 30th day following election 20th day of January <br />preliminary/primary (Town or Special) (Year -End Report)' <br />Pursuant to M.G.L., Chapter 55: <br />1. I certify that I am a candidate for or hold Municipal Office. <br />2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this <br />reporting period, and do not have a campaign fund in existence. <br />3. I certify that I do not have a political committee. <br />DATE <br />I. SIGNATURE <br />under the penalties of perjury <br />1I. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III. OFFICE SOUGHT <br />Eft- I t , <br />S igned <br />l i a � t <br />d 1 4- L Ot `,C —R At � � A AL- <br />11/7/ <br />CJ <br />