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Form CM101: SOF ORGANIZATION CANDIDATE'S COMMITTEE r MFORM Commonwealth office of Campaignand Political Finance of Massachusetts Pile with: City l Town Clerk or Election Cominission NOTICE IS HEREBY GIVEN in accordance with the provisions ofGeneral Daws, Chapter 55, as amended, of the organization of candidate's committee as follows: CANDIDATE: Full Name: � Residential Address, City/State l Zip: k E-Mail Address: -� 1 �► �.t Phone#: Party Affiliation: If applicable) OFFICE SOUGHT/PURPOSE: Title: District: - COMMITTEE: Name of Committee. (The name of the committee must include the candidate's last name) Committee Mailing Address: City/State/Zip: L-ex- W1 Phone#: OFFICERS: t Chairman: '' Treasurer*: ?44�_ BLI r JOE% Residential Address: eke" AResidential Address: -3 7 City/State 1 Zip: �, � �A 10 PA �ll� City I State!Zip: 4rl 1A 1, Phone#: Phone#: W 7,77�* ��1nail. - *A public employee inay not serve as treasurer of any political committee see reverse.). OtherOfficer/Title: OtherOfficer/Title: Residential Address: Residential Address: }. W City 1 State 1Z 1p, City State I Zip. Phone#: Phone 4- (Complete and attach a Form CPP M 101,i necessary,with other officers and fi nary ce committee,if a, ,��'y F=a ; .f..::� �.�sib. I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of , .7'-'ha, . no ne �t��t�ttee��n.l�is�l� r behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign finance activity for a'Period of sk yeatsrlrom the date of the relevant election. SIGNED UNDER THE PENALTIES OF PERJURY: Date. idate's ' Cn tore I hereby accept the office of Treasurer of the above-name mmitte5, ffirm that I am not public employee a defined by M. r.L.c. , . 13.I understand p F l� that: 1 I am subject to certain duties and liabilities under M. .L.c. cluding 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; if after my acceptance of this office I become an appointed public employee,J must resign this position and notify G PP of my resignation;and 3 a candidate may not serve as treasurer of the political committee organized on his/her behalf. SIGNED UNDER THE PENALTIES OF PERJURY: Date: , surer}s signatur I hereby accept the office of Chairman of the above-named committee, SIGNED[ANDER THE PENALTIES OF PERJURY: �x oa /, irm ' signature Date: w