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6. Liabilities and promises to pay:
<br />Date Made or
<br />Incurred*
<br />To Whom Due
<br />Address
<br />; Purpose
<br />Amount **
<br />ru
<br />Total liabilities on this report
<br />Total liabilities previously reported and currently outstanding
<br />Total outstanding liabilities
<br />* A promise to pay exists and must be reported if the corporation, organization or individual has (1) made an express or implied
<br />promise to give, pay, expend or contribute money or anything of value or (2) knows or reasonably should know that they will
<br />be responsible for paying for a good or service. A liability exists and must be reported if the corporation, organization or
<br />individual has received a good or service which has not been paid for even if the corporation, organization or individual has
<br />not received a bill or invoice.
<br />** If the amount of the liability has not been determined or is in dispute, the liability should be estimated or reported as "to be
<br />determined" or "in dispute."
<br />I certify that this report is a true statement of the amount or value of every gift, payment, expenditure or contribution or promise to
<br />give, pay, expend or contribute in order to influence or affect the vote on the question referenced on the front of this report,
<br />together with the date, purpose, and full name and address of the person to whom it was made, I make this report in accordance
<br />with the requirements of Massachusetts General Laws, Chapter 55, Section 22, as amended.
<br />Signed under the penalties of perjury:
<br />Signature of cm' 'horation /organization
<br />11) -s
<br />ividual Print Name
<br />Date
<br />3
<br />M.G.L. Chapter 55, Section 22 states in part:
<br />Any person or the treasurer of a corporation, association, organization or other group of persons, other than a political committee organized
<br />tinder section 5, which has given, paid, expended or contributed, or promised to give, pay, expend or contribute, any money or other thing of
<br />value in order to influence or affect the vote on any question submitted to the voters shall file reports setting forth the amount or value of every
<br />gift, payment, expenditure or contribution or promise to give, pay, expend or contribute, together with the date, purpose and full name crud
<br />address of the person to whom it was made.
<br />Any person who makes an expenditure of $250 or more other than a contribution to a ballot question committee or incurs a liability of $250 or
<br />more to influence or affect the vote on any question submitted to the voters shall file reports setting forth the amount or value of the expenditure
<br />or liabililty, together with the date, purpose and full name of the person to whom the expenditure was made or the liability incurred.
<br />If the question appears on ballots at a city or town election or appears on ballots for use in a city or town at a state election, such report shall
<br />be filed with the city or town clerk as follows: (1) the eighth day preceding a preliminary or primary, including a caucus, the eighth day
<br />preceding a city or town election and, if a ciq) election, as a final report, the twentieth day ofdanuary in the following year, complete as of the
<br />thirty-first day of December of the prior year and, if a town election, as a final report, the thirtieth day following such election; (2) the eighth
<br />day preceding a special primary, including a caucus, the eighth day preceding a special election and, as a final report, the thirtieth day
<br />following a special election; and (3) the twentieth day ofJanuary of each year, complete as of the thirty -first day of December of the prior year,
<br />until all declared liabilities ofsuch person or corporation, association, organization or other group ofpersons have been discharged. [Except
<br />for the Jan. 20 report, all reports must be complete as of the preceding tenth day.]
<br />Any person or corporation, association, organization or other group of persons, other than apolitical committee organized under said section
<br />5, violating any provision of this section shall be punished by a fine of not more than $50, 000 and any officer, director or agent of any such
<br />person or corporation, association, organization or other group of persons violating any provision hereof or authorizing any such violation or
<br />any person who violates or in any way knowingly aids or abets the violation of any provision hereof shall be punished by a fine of not more than
<br />$10,000 or by imprisonment for not more than one year or by both such fine and imprisonment.
<br />11/09
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