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Form CPF M109: <br /> Statement of Municipal Candidate R4y 7 <br /> Not Raising or Expending Campaign Funds ¢ <br /> Commonwealth 2927 i B —}3 F p�M i{ ` 4, <br /> ofmassnchusetts Office of Campaign and Political Finance <br /> File with: Local Election Official(City or Town Clerk) TOWN W CLERK <br /> LEXINGTON HA <br /> Candidate's Name: 4/ ,f 5. h --,e�l a J, ,_f' C- <br /> cry S /vz d T r <br /> Office Sought: G-� �' J �,.. �-��-�- l`rf� �� � 2L <br /> Residential Address: oi"t r- <br /> City I State/Zip: >C <br /> E-Mail Address: 2 `� / Phone Number: �'� <br /> I hereby certify that I have not opened a campaign bank account for campaign funds because I do not intend to accept <br /> contributions or in-kind contributions,make expenditures,including expenditures of my own funds, or incur liabilities <br /> for any campaign-related purpose,nor do I currently have any outstanding liabilities for prior campaign-related activity. <br /> I submit the following as my campaign report for all bank reporting periods in this calendar year as provided for in Chapter 55 <br /> 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 /> After filing this statement,if I decide to raise, accept,or expend funds,or incur liabilities, for a campaign-related <br /> purpose,I will immediately notify my local election official in writing, and will file periodic campaign finance reports <br /> according to the statutory filing schedule. <br /> Until such notice is on file with the local election official, I certify that the above Zero report will be in effect for each <br /> reporting period,in the calendar year in which it is filed,required by Chapter 55 of the Massachusetts General Laws. <br /> This form is valid through December 31 of the year in which it was signed. <br /> SIGNED UNDER THE PENALTIES OF PERJURY: <br /> /I/-Z <br /> Candidate signature: Date: <br /> M109 12121 <br />