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Form CPF M 102: Campaign Finance Report <br />Municipal Form p <br />Office of Campaign and Political Finance .. <br />File with: <br />City or Town Cleric or Election Commission L <br />riease print or type an tniorinatton, except signatures. f tw N, H ¢I <br />Fill in dates: Month Date Yaw M«ue Date year <br />Rep Period Beginnin .__0 '1 01 7- 0 t -3 Ending 4 _ - I <br />Type of report: (Check one) <br />08th day preceding preliminary gth day preceding election 030 day after election 0year -end report ❑dissolution <br />Committee Name <br />Name of Committee Treasurer <br />Tel. No. (optional) <br />Committee Mailing Address <br />Tel. No. (optional) <br />SUMMARY BALANCE INFORMATION; <br />Line 1: Ending balance from previous report <br />Line 2: Total receipts this period (page 2, line 11) <br />Line 3: Subtotal (line 1 plus line 2) <br />Line 4: Total expenditures this period (page 3, line 14) <br />Line 5: Ending balance (line 3 minus line 4) <br />------------------------------- -- - <br />Line 6: Total in -kind contributions this period (page 4) <br />Line 7: Total (all) outstanding liabilities (page 4) <br />Line 8: Name of bank(s) used <br />Affidavit of Committee Treasurer. <br />I cer* that I have examined Oda report including ansd►ed sc!"les and it is, to the best of my knowledge and belief, a true and complete statement of all campaign <br />finance activity, including all contributions, loans, roceipts, expenditures, disbumanans. 41-W d contributions and liabilities for this reporting period and represents the <br />campaign finance activity of all persons acting under the suUnoity or on behalf of this committee in accordance with the requirements of M.G.L c. SS. <br />Signed under the penalties of perjury: <br />Treasurer's signature (in ink) Date <br />FOR CANDIDATE FILINGS ONLY: (CANDIDATE MUST SIGN BELOW) <br />Affidavit of candidate: (check t box only) <br />❑ Candidate with Committee and no adh* Independent of the committee <br />I outify that I have examined this report including afadud schedules and it is, to the best of my knowledge and belief a true and complete datemKUt of all campaign <br />finance activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L a 55. 1 have not received any <br />butions, incurred any liabilities nor nude any expenditures on my behalf during this reporting period. <br />Candidate without Committee OR Candidate with Independent activity Ming separate report <br />I certify that I have examined this report including attadned schedules and it is, to the best of my knowledge and belief awe and complete statement of all campaign <br />finance activity, including contributions, loam, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and repreacnts the <br />campaign finance activity of all Persons acting under the authority or on behalf of this comnuttee in accordance with the requirements of M.G.L c. 55. <br />ed undeohe penalties of perjury: <br />S <br />signature (in ink) <br />