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Form CPF M 102: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />Commonwealth <br />of Massachusetts <br />File with• City or Town Clerk or Election Comm issior <br />Fill in Reporting Period dates: Beginning Date: t Ending Date: -; <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election year -end report ❑ dissolution <br />Residential Address <br />Telephone Number (optional); 1 a 1 <br />i t ` 12 S° d 4--' i <br />Committee Name <br />r V � t <br />Name of Committee Treasurer <br />&PAIAL <br />Committee Mailing Address <br />Telephone Number (optional): &/;—/ —0-&-9— t <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending Balance from previous report <br />Line 2: Total receipts this period (page 3, line 11) <br />Line 3: Subtotal (line 1 plus line 2) <br />Line 4: Total expenditures this period (page 5, line 14) <br />Line S: Ending Balance (line 3 minus line 4) <br />Line 6: Total in -kind contributions this period (page 6) <br />Line 7: Total (all) outstanding liabilities (page 7) <br />Line 8: Name of banks) used: `rp tr <br />RT <br />� c <br />Affidavit of Committee Treasurer: <br />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 <br />activity, including all contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign <br />finance activity of all persons acting under tho authority or on behalf of this committees in accordance with the requirements of M.G,L, C. 55. <br />Signed under the penalties of perjury: i ; del 2t �, ( (Treasurer's signature) Date: " <br />Affidavit of Candidate: (check I box only) <br />C didate with Committee and no activity independent of the committee <br />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 <br />activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M,G.L, o, 55, I have not received any contributions, <br />incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br />Candidate without Committee OR Candidate with Independent activity filing separate report <br />❑ 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 <br />finance activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the <br />campaign finance 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. <br />Signed under the penalties of perjury; i (Candidate's signature) Date: <br />