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Form CPF M 102: Campaign Finance Report <br /> co Municipal Form <br /> Office of Campaign and Political Finance <br /> ,z rrr .fie* # � <br /> .�F� �u ' �i`' Y� i <br /> orn nionwealdi - - -- LIJI <br /> of Massachusetts <br /> File with: CLty or Town Clerk or Election Commission <br /> Fill in . rtin Period d .t : Beginning Dat : ding late: <br /> La <br /> : . <br /> 'Type of Report: (Check orae) <br /> .13 .8th day preceding preliminary 13:8th day preceding election 1330 day after election ear-end report ® dissolution <br /> Candidate Fall Name if applicable) Committee Dame <br /> gC*-t CZPOA "Sm <br /> Office sought and District LocrmorrONM lame f Committee Treasurer <br /> eok�TVIL— L&IPJLn:Q.N _MPnqP-1 <br /> Residential Address C17 <br /> ee Mailing Address <br /> E-mail: �t �IA � � � E-mail: <br /> Phone#: q0 Phone# <br /> SUMMARY BALANCE INFORMA ION z , <br /> Line 1: Ending Balance from previous report <br /> t <br /> Line : Total receipts this period(page 3,line 1 Cro <br /> Line : Subtotal(line 1 plus line 1 OT <br /> Line 4: Total expenditures this period(page 5,line 1 <br /> Line : Ending Balance(line minus line 410 ,0 <br /> Line 6: Total in-find contributions this period(page 6,lino 1 � <br /> Line : Total(all)outstanding liabilities page 7,line 19 IV <br /> Line : Total out-of-pocket expenses this period(page 8,line 22) <br /> Line 9: Marne of bank(s)used: 6 e: <br /> Affidavit of Committee Treasurer: <br /> I certify that i have examined this report including attached schedule's and it is,,to the best of my knowledge and belief a true and complete statement ofall 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 the authority or t. .on behalf of this committee in accordance with the requirements of 11 . .L.c. . <br /> Signed under thenaltie \ <br /> p of perjury. (Treasurer's signature) Date: <br /> FOR CANDIDATE FILINGS ONLY: Affidavit ofCandidate:(check 1 box only <br /> Candidate with Committee <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,of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M. .L.c.55. I have not received any contributions, <br /> incurred any liabilities nor made any expenditures on my behalf during this reporting period that are not otherwise disclosed in this report. <br /> didate without 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 <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 candidate in accordance with the requirements ofM.G.L.c.55. <br /> f <br /> Date- ' . <br /> Signed under the penalties of penury; (Candidate's signature) ... <br /> X rF-1 nn /I{1 Y1 fit?-p <br />