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Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Commonwealth of Massachusetts Z.- ' Fil with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: JAA& 1 2-0 V1 Ending Date: A- 7.c� {; Type of Report: (Check one) r ® 8th day preceding preliminary 124h day preceding election ® 30 day after election year-end.report ® dissolution 1 - � S kw Vi N-01 tl& Candidate Full Name(if applicable) 06inniftee Name Office Sought and District Name of Committee Treasurer Residential Address 07-q 2-0 Committee Mailing Address E-mail: � J�� c CSC e—e— r �5��. E-mail: AA Phone#: 6 4 o Phone 4: SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report b Line 2: Total receipts this period(page 3,line 12) p - Line 3: Subtotal(line 1 plus line 2) Line 4: Total expenditures this period(page 5,Iine 15) 6 1 Y 6 Line 5: Ending Balance(line 3 minus line 4) 6 Line 6: Total in-kind contributions this period(page b,line 18) (7� Line 7: Total(all)outstanding liabilities(page 7,line 19) Line 8: Total out-of-pocket expenses this period(page 8,line 22) L( L( Line 9: Name of bank(s)used: NCyr Affidavit of Committee Treasurer: 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,including all 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 behalfof this committee in accordance with the requirements of M.G.L.c.55. Signed under the penalties of perjury: 'v I (Treasurer's signature) Date: FOR CANDIDATE FILINGS_ONLY: Affidavit of Candidate:(check 1 box only) Candidate with 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. 1 have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period that are not otherwise disclosed in this report. ndidate without 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,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 candidate in accordance with the requirements of M.G.L.c.55. Signed under the penalties of perjury; (Candidate's signature) Date: P,119 '2-9r rri n� ii-i r�nnn�