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. RECEIVED <br /> Form CPF M109: 2023 25 Jan, 10:14 am <br /> 5tatement"of Municipal Candidate <br /> Not Raising-or'Expending Campaign Funds <br /> Commonwealth . To W N CLERK <br /> of Massachusetts Office of Campaign and Political Finance <br /> File with: Local Election Official(City.or Town Clerk) LEXINGTON <br /> Candidate's Name: Charles Hornig <br /> Office Sought: Planning Board <br /> Residential Address: 18 Bacon Street <br /> City,State,Zip: Lexington MA 02421 <br /> E-Mail Address: hornig.lex@charieshQrnig.org phone Number: 781 -862-1112 <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 /> I. 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 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 /> �G <br /> Candidate's signature: ate:, -�7�u Z3 <br /> M109 12121 <br />