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Commonwealth of Massachusetts Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance File with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: Iit7 /l7 Ending Date: z /y7 )j7 Type of Report: (Check one) ❑ 8th day preceding preliminary 8th day preceding election ❑ 30 day after election ❑ year -end report ❑ dissolution Committee Name Name of Committee Treasurer Committee Mailing Address Telephone Number (optional): SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period (page 3, line 11) Line 3: Subtotal (line 1 plus line 2) Line 4: Total expenditures this period (page 5, line 14) Line 5: Ending Balance (line 3 minus line 4) 1 Line 6: Total in -kind contributions this period (page 6) Line '7: Total (all) outstanding liabilities (page 7) Line 8: Name of bank(s) used: Affidavit of Committee Treasurer: I certify that I have examined this report including attached schedules activity, including all contributions, loans, receipts, p finance activity of all persons acting under the au on , to the best .f my knowledge and belief, a true and complete statement of all campaign finance ex e.. =.nts, in -ki contributions and liabilities for this reporting period and represents the campaign alf committe fn accordance with the requirements of M.G.L. c. 55. -- - Signed under the penalties of perjury: msem of tl (Treasurer's signature) Date: FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) Candidate with Committee and no activity independent of the committee 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 ❑ activity, of' all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Caaydidate without Committee OR Candidate with independent activity filing separate report 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 Pia finance activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G L. c. 55. Signed under the penalties of perjury: ii G7 /744 _ (Candidate's signature) Date: z/2-7/77 Candidate Full • . me (if applicable) 1 Vrar i„h;) r®„�r",}krr I Office Sought and District 1 1 lP1V) rt'lyy *o h 1 _P /I A(1� D\ Residential Address Telephone Number (optional): 47 7 q - 76, 4 - &' , Committee Name Name of Committee Treasurer Committee Mailing Address Telephone Number (optional): SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period (page 3, line 11) Line 3: Subtotal (line 1 plus line 2) Line 4: Total expenditures this period (page 5, line 14) Line 5: Ending Balance (line 3 minus line 4) 1 Line 6: Total in -kind contributions this period (page 6) Line '7: Total (all) outstanding liabilities (page 7) Line 8: Name of bank(s) used: Affidavit of Committee Treasurer: I certify that I have examined this report including attached schedules activity, including all contributions, loans, receipts, p finance activity of all persons acting under the au on , to the best .f my knowledge and belief, a true and complete statement of all campaign finance ex e.. =.nts, in -ki contributions and liabilities for this reporting period and represents the campaign alf committe fn accordance with the requirements of M.G.L. c. 55. -- - Signed under the penalties of perjury: msem of tl (Treasurer's signature) Date: FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) Candidate with Committee and no activity independent of the committee 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 ❑ activity, of' all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Caaydidate without Committee OR Candidate with independent activity filing separate report 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 Pia finance activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G L. c. 55. Signed under the penalties of perjury: ii G7 /744 _ (Candidate's signature) Date: z/2-7/77