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City or Town of �L I Cam_ Candidate e r <br />Please print or type all Information, except signatures, <br />Office <br />Fill in dates: <br />Month Aa <br />Year pnth ay <br />Year <br />Reporting Period Beginning <br />Ending 1 <br />Type of Report: (Check One) . <br />® 8th day preceding ® 8th day preceding election ® 30th day following election 20th day of January <br />preliminary/primary (Town or Special) (Year -End Report)' <br />Pursuant to MAL., Chapter 55: <br />1, I certify that I am a candidate for or hold Municipal Office, <br />2. I certify that 1 have not received any contributions, made any expenditures, or Incurred any obligations during this <br />reporting period, and do not have a campaign fund in existence. <br />3. I certify that I do not have a political committee, <br />10 <br />