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Form CPF M101: STATEMENT OF ORGANIZATION CANDIDATE OR CANDIDATE'S COMMITTEE MUNICIPAL FORM t-t Commonwealth Office of Campaign and Political Finance of Massachusetts ' 45 File with: City/Town Clerk or Election Commission NOTICE IS 1EMEBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amend 'ift a candidate or candidate's committee as follows: CANDIDATE: Fun Name: Kunal P. Botla Residential Address: 40 Grapevine Avenue City/state I Zip.- Lexington, MA 02421 E-Mail Address: kunal@kunalbotta.com Phone#: 617-792-8685 Party Affiliation: (if applicable) OFFICE SOUGHT/PURPOSE: Title: Town Meeting Member, Precinct 4 District: Lexington Candidate without committee(check if applicable) If checked,do not complete committee or officer sections,sign as candidate, date and file with clerk or local election official. COMMITTEE: Name of Committee: Committee to Elect Kunal Both (the name of the committee must include the,candidate's last name) Committee Mailing Address-40 Grapevine Avenue City/state/Zip: Lexington MA 02421 Phone 4: 617-792-8685 OFFICERS: Chairperson: Kunal P. Botta Treasurer*: Va X 13 AL X Jt,J LY,Pi K N Residential Address:40 Grapevine Avenue Residential Address: c:25 V-VARS`I) City/State/zlp- Lexington MA 02421 city I state/zip: L—E—X I W (/1-1 0-11A t--\1A ©'2 4 1 Phone#: 617-792-8685 Phone#: -78k --1-2-4-453J'E-ail: �S e VA Public employee may not serve as treasurer of any 1)olitical committee see reverse)- Additional officers may be listed on page two. Check applicable box before signing: X Candidate with committee:I hereby 1)consent to this filing;2)understand that a candidate shall not consent to the organization of more than one account or committee on their behalf 3)am subject to certain duties and liabilities under NiG.L.c.55,including the timely filing of campaign(mance reports and keeping detailed accounts and records of all campaign finance activity for a period of six years from the date of the relevant election;and 4)may not serve as treasurer of a political committee organized on my behalf. F-1 Candidate without committee:I hereby 1)consent to this filing-,2)understand that a candidate shall not consent to the organization of more than one account or committee on their behalf 3)acknowledge if I become a public employee I must organize a committee and may not serve as treasurer,and 4)am subject to certain duties and liabilities under M.G.L.c.55 including the timely filing of campaign finance reports and keeping detailed accounts and records of all campaign finance activity for a period of six years from the date of the relevant election. SIGNED BMER THE PENALTIES OF PERJURY: Date: 1r-1ZS/Zc-z-& Candidatds signature I hereby accept the office of Treasurer of the above-named committee.I affum that I am not a public employee as defined by MG-L.c.55,& 13.1 understand that: 1)1 am subject to certain duties and liabilities under M.G.L.c.55,including the timely filing of campaign finance reports and keeping detailed amounts and records of all campaign fixuatce activity for a period of six years from the date of the relevant election;2)if after my acceptance of this office Y become an appointed public employee,I must resign this position and notify 0CPF of my resignation;and 3)a candidate may not serve as treasurer of the political committee organized on their behalf. SIGNED UNDER TOE PENALTIES OF PERJURY Treamvcs siDate: 7 1 2,0'13� ? gnature I hereby accept the office of Chairperson of the above-named committee. &�� 2,4-7 Date: SIGNED UNDER TBE PENALTIES OF PERfURY: Jpp-0 Chairperson's signature