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Commo <br />of N1assochucetts <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: Beginning: <br />(MM D/YYYt) <br />i(0 <br />Ending: <br />Please pr/nt or type all fnfarmation, except sigr <br />ori ( b <br />(xM <br />IND/YYY <br />Type of Report: (Check One) <br />8th day preceding preliminary/printery © 8th day preceding election <br />5:1,316i. ---h day following election (town or special) 0 20th day of January (Year -End report) <br />Pursuant to M.G.L. Chapter 55: <br />1. I certify that I am a candidate for or currently hold Municipal Office. <br />2. I 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. I certify that I do not have a political committee. <br />DATE <br />PRINT NAME <br />SIGNATURE <br />Signed under the penalties of perj <br />SID <br />(SU <br />L'IAL ADDRESS <br />and Number) <br />OFFICE SOUGET <br />'cit/ 4,7D17 <br />TC'(jcr"-A <br />tl cen <br />61.1\ <br />`f7 , obinSCt PCI <br />4'/2 <br />9/ <br />v-- <br />,L..` <br />