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MEMO Form CPF M 102: Campaign Finance Report Municipal Form Otnce of Campaign and Political Firume i€ y r U C 3 I2 t File with City or Town Clerk or Election Commission Please print or type all information, except signatures. Fill in dates: Month Due Ye DW Yea Reporting Period Beginnin ( ,. i � Ending 7 4 F Tel. Na (optional) Tel. No. (optional) SUMMARY BALANCE INFORMA' Line 1: Ending balance from previous report Line 2: Total receipts this period (page 2, line 11) Line 3: Subtotal nine i plus line 2) Line 4: Total expenditures this period (page 3 line 14) Line 5: Ending balance (line 3 minus line 4) i $ ------------------------------- -- - Line 6: Total in -kind contributions this period (page 4) $ Line 7: Total (all) outstanding liabilities (page 4) $ Line S: Name of bank(s) use Afndavk of Committee Tressurer. I artily that I have examined this report including attached schedules and it it, to the best of my knowledge and belief; a true and complete statement of all campaign finance activity, including all contribution, loans, receipts, expenditures, disi xtrzanco M k kind contributions and liabilities for this reporting period and represents the Campaign finance persons acting under the authority or on behalf of this committee in accordance with the requirements ofM.G.L c. 55. Signed under the penalties of perjury: signature FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW) Anidavit of Candidate: (check 1 box only) ❑ Candidate with Committee and no activity' Independent of the commmittee I artily that I have examined this report including attached schedules and it is, to the best of my knowledge and belied a true and complete statemerd of all 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 e. 55. 1 have not received any contribution, incurred any liabilities nor nude any wpenddUfm on my behalf during this reporting period. O CAndWate without Committee OR Candidate with Independent settvity filing separate report I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belied a true and complete statement of all campaign finance activity, including contributions, loans, 'cats, expeadituas, disbursements, in," contributions and liabilities for this reporting period and represents the Campaign finance activity f all persons acting the authority or on bdulf of this committee in accordance with the requirements of M.G.L. c. 55. Signed under the penalties of perjury: Date