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Fill in dates: Mond as Yew Moeub Dnto Y em <br />Reporting Period Beginning t y r 7- t 0 En ding ` a <br />Type of report: (Check one) <br />08th day preceding preliminary 08th day preceding election 030 day after election year -end report Odissolution <br />t rw Sf i7�? A. A L&S�{}ry <br />Full Name of Candidate (If <br />�'�l >� ��r i�:� ��e:X F1' <br />Office Sought and Di H $ <br />Residential Address '�z Ll 21 <br />TeL No. (optional) <br />Committee Name <br />Name of Committee Treasurer <br />Committee Mailing Address <br />Tel. No. (optional) <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending balance from previous report <br />$ <br />Line 2: Total receipts this period (page 2, line 11) <br />$ <br />Line 3 : Subtotal (line I plus line 2) <br />$' <br />Line 4: Total expenditures this period (page 3, line la) <br />$ < <br />Line 5: Ending balance (lino 3 minus One 4) <br />$ <br />Line 6: Total in -kind eontributionls t14is period (page a> <br />S <br />Line 7: Total (all) outstanding liabilities (page a) <br />$ <br />Line 8: Name of bank(s) used <br />AM*vlt of Committee Treasurers <br />I oatify that I have examined this report including attaeled scl"Ies and it * to the best of my knowledge and belief, a true and complete satamem of all campaign <br />fuanoe activity, including all owtributl=4 loans, raoeipts, expenditures, disburawnaro, LAfnd contributions and liabilities for this reporting period and represents the <br />campaign firuance activity of all persons acting under the authority or on behalf of this committee In accordance with the requirements of M.0,1- c, 15. <br />Signed under the penalties of perjuryt <br />Treasurer's signature (in ink) Date <br />FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW) <br />r NS <br />AttWavlt of Candidate: (elueek I box only) <br />O Candidate with Comndttee and no activity independent of the committee <br />I outify that I have examined this report including stacked schedules and k a, to the best of my knowledge and belief a true and eompleto statement *fail campaign <br />Snanco activity, of all pas" sling under the authority or on bekatf of rite ommittee in accordance with the requirements of M.O.L o. $3. I have not received any <br />oapin butions, incurred any liabilMa nor made any expe dWra on my behalf during this reporting period. <br />oeX andidate without Committee Q$ Candidate with Independent astivity flung separate report <br />i oadfy that I have examined d4 report including sttaohod scl"les and it is, to the beat of my knowledge and belief a true and complete ststowd of all carrgwgn <br />Mane activity, including contributions, loans, receipts, axpanditures, its, in." contributions and liabilities for this reporting period and rolxese o the <br />campaign ttnsnrco acovilyoftil personyadins under the sudwrity or on behalf of oomrnitleo in accordance with the requirements of M.O.L. c. SS. <br />i s►n er petalUa perinea; <br />Cam ate gatnre ( ink) co <br />