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Comrn wealth <br />ofMassachusets <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />City or Town of <br />Reporting Period: <br />Beginning: <br />Please print or type all information, except signatures. <br />O/ /61/724:17 <br />(MVUDD/Y YY) <br />Ending: <br />(M DNY Y) <br />Type of Report: (Check One) <br />Ith day preceding preliminary /primary D 8th day preceding election 0 30th day following election (town or special) 0 20th day of January (Year -End report) <br />Pursuant to M.G.L. Chapter 55: <br />I. f certify that 1 am a candidate for or currently hold Municipal Office. <br />2.1 certify that I have not received any contributions, made any expenditures, or incurred any obligations during this reporting period, and do not have a campaign fund in existence. <br />3 -1 certify that 1 do not have a political committee. <br />DATE <br />SIGNATURE <br />PRINT NAME Signed under the penalties of perjury <br />)yvey /alas l /c vicX <br />RESIDENTIAL ADDRESS <br />(Street and Number) <br />OFFICE SOUGHT <br />30 Ox.b a w Ro ed <br />ScJoa/ Comm; Net <br />