2012-12-31-Burnell-OCPF-Dissolution

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Form CPF M 102: Campaign Finance Report Municipal Form i � Office of Campaign and Political Finance VED 1013 JA 10 PM 3 09 Commonwealth of Mnsgachngattq -- --------------- -- File with: ra Ve ToV QerK% Election Commission Fill in Reporting Period dates: Beginning Date: 1/1/2012 Ending Date: L /12A JA Type of Report: (Check one) ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year -end report ❑X dissolution George Burnell Candidate Full Name (if applicable) Selectman Office Sought and District George Burnell for Selectman Committee Name Ann Redmon Name of Committee Treasurer SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period (page 3, line 11) Line 3: Subtotal (line 1 plus line 2) Line 4: Total expenditures this period (page 5, line 14) Line 5: Ending Balance (line 3 minus line 4) 161.92 161.92 �_- 161.92 Line 6: Total in -kind contributions this period (page 6) Line 7: Total (all) outstanding liabilities (page 7) 377.78 Line 8: Name of bank(s) used: I Sovereign Bank affidavit of Committee Treasurer: 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 ictivity, including all contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting under the authority or - half of this committee in accordance with the requirements of M.G.L. c. 55. gned under the penalties of perjury: (Treasurer's signature) Date: Affidavit of Candidate: (check 1 box only) Candidate with Committee and no activity independent of the committee ' n 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 tJ 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, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Candidate without Committee OR Candidate with independent activity filing separate report 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 activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting un th authority or on h f of this committee in accordance with the requirements of M.G.L. c. 55. Signed under the penalties of perjury: (Candidate's signature) Date: