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RECEIVED <br /> (1"01'Qffiree Use 017114 <br /> 2022 01 Feb,11:20 am <br /> Form CPQ` D104: <br /> TOWN CLERK Statement of Candidate <br /> coltinionwealth LEXINGTON MA Not Raising or Expending Campaign Funds <br /> ofMassachusetts <br /> Office of Camaign and Political Finance <br /> P <br /> Filcwith: Director <br /> (617)979-8300 (900)462-QCP[." <br /> Office of Caritpaign and Political 1"inance <br /> ocpf Cqrrcpf.stalc.nia.us <br /> One Ashburtoa Place,Room 4 E I,k Aston,MA 02 108 <br /> httP:flWw%V.0CjWt45 <br /> CHECK ONE: Ido not have a political committee. OR <br /> I have organized a political Gomnlittee on my behalf. <br /> Candidate's Name: se_J)'ee <br /> Office Sought/District: lowill —Ate&m u Ply- <br /> A <br /> Residential Address: finIA, <br /> City State I Zip: 09�i AT) <br /> E-Mail Address: 10@!w0%'V1 - CQO& Phone Number: 2.[SR <br /> \j <br /> 1 hereby certify that I have not opened a campaign bank 1000Unt for campaign funds because I do not intend to accept <br /> contributions, make expenditures, including expenditures of my own funds, or incur liabilities for any campaign-related <br /> purpose. I submit the following as my campaign report for all bank reporting periods in this election cycle as provided for in <br /> Chapter 55 of the Massachusetts General Laws: <br /> 1. Ending balance from previous report ZERO <br /> 2. Total receipts for reporting period ZERO <br /> 3. Subtotal ZERO <br /> 4. Total Expenditures for reporting period ZERO <br /> 5. Ending balance ZERO <br /> If, after filing this statement, I decide to raise or expend funds for a earn paign-related purpose, I will immediately <br /> designate a depository bank., open an account at the designated batik, and complete and file an Appointment of Depository Bank <br /> {D103)Form. <br /> Until such notice is on file with the Director, I certify that the above Zero report will be in effect for each reporting period <br /> required by Chapter 55 of the Massachusetts General Laws. <br /> SIGNED UNDER THE PENALTIES OF PERJURY: <br /> �Andidate'(Tggnature Date:F60rot � o z <br /> D104 10,121 <br />