HomeMy WebLinkAbout2019-01-08-Sandeen-OCPF Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
MUNICIPAL FORM
Commonwealth Office of Campaign and Political Finance
of Massachusetts JfiIg
i
File with: City/Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws, Chapter 55,as ame�i „'dhe organization of a
candidate's committee as follows:
CANDIDATE: Full Name. Mark Douglas Sandeen
Residential Address: 10 Brent Road
City/State 1 Zip: Lexington MA 02420
E-Mail Address: mark@marksandeen.com Phone 9: 781-863-8784
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Title: Selectmen
District: Town of Lexington
COMMITTEE: Name of Committee: Committee to Elect Mark Sandeen
(The name of the committee must include the candidate's last name)
Committee Mailing Address: 10 Brent Road
City/State/Zip: Lexington MA 02420 Phone#: 781-863-8784
OFFICERS:
Chairman: Todd Burger Treasurer*: Jeanne Krieger
Residential Address: 386 Lincoln Street Residential Address: 44 Webster Road
City 1 State I Zip: Lexington MA 02421 City I State I Zip: Lexington MA 02421
Phone#: 781-820-2521 Phonefl: 781-862-7730 Email: kriegerjk44@gmail.com
*A public employee may not serve as treasurer of ally pohtical committee see reverse.
Other Officer/Title: Other Officerfritle:
Residential Address: Residential.Address:
City/State I Zip: City/State/zip;
Phone{l: Phone#:
(Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,if any.)
I hereby consent to the filing of this committee. 1 understand that a candidate shall not give consent to the organization of more than one committee on his/her
behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY:
Date:
Candidate's signature
I hereby accept die office of Treasurer of the above-named committee.I affirm that I am not a public employee as defined by M.G.L.c.55,S. 13.1 understand
that: 1)1 am subject to certain duties and liabilities under M.G.L.c,55, including the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of sixyears from the date of the relevant election;2)if after my acceptance of this office I become an
appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political
committee organized on his/her behalf,
SIGNED UNDER THE PENALTIES OF PERJURY: y J
l�t/t.E•. Date:
Treasurer's signature
I hereby accept the office of Chairman of the above-named co itee,
SIGNED UNDER THE PENALTIES OF PERJURY:
Date:
Chairman's signature / �