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�a\_ 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 Date: 1 1 2- 3 I / 1 1
<br />Type of Report: (Check one)
<br />❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year -end report ❑ dissolution
<br />" W i `Ps-v
<br />Committee Name
<br />FU e tti ' 6, t L
<br />Name of Committee Treasurer
<br />,e xt. ti 0242
<br />Committee Mailing Address
<br />Telephone Number (optional): 3 3 , — 2 2 J A
<br />SUMMARY BALANCE INFORMATION:
<br />X
<br />< -s
<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) 0
<br />Line 7: Total (all) outstanding liabilities (page 7) 0
<br />Line 8: Name of bank(s) used: �a,4 U
<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 accordance with the requirements of M.G.L. c. 55.
<br />Signed under the penalties of perjury: (Treasurer's signature) Date: I I 1 20 (
<br />Affidavit of Candidate: (checkq -b6x 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 />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 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 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: ( 7 - f E%
<br />Candidate FJd Name (if ap icable)
<br />i Q (
<br />& - A `
<br />Office So
<br />ht and District
<br />�e See
<br />1-cj 1A , M. 02 z
<br />Residential Address
<br />Telephone Number (optional):
<br />" W i `Ps-v
<br />Committee Name
<br />FU e tti ' 6, t L
<br />Name of Committee Treasurer
<br />,e xt. ti 0242
<br />Committee Mailing Address
<br />Telephone Number (optional): 3 3 , — 2 2 J A
<br />SUMMARY BALANCE INFORMATION:
<br />X
<br />< -s
<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) 0
<br />Line 7: Total (all) outstanding liabilities (page 7) 0
<br />Line 8: Name of bank(s) used: �a,4 U
<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 accordance with the requirements of M.G.L. c. 55.
<br />Signed under the penalties of perjury: (Treasurer's signature) Date: I I 1 20 (
<br />Affidavit of Candidate: (checkq -b6x 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 />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 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 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: ( 7 - f E%
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