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Commonwealth <br />of Massachusetts <br />Form CPF M 102: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />File with: Citv or Town Clerk or Election Commission <br />Fill in Reporting Period dates: Beginning Date: <br />LEX <br />tit Z1 n <br />Ending Date: <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary ❑ 8th day preceding election 30 day after election ❑ year-end reportdissolution <br />Ikc (e XkAnn <br />Candidate Full Name (if applicable) <br />Ck,W \ co r--LA.--A{i-u--- 1---e_.--V4_,-- <br />— --p2'Office <br />officeSought and District <br />7 <br />lop ce(Co,-- gtos-c- uptc i tt�.-- rLA\ <br />Residential Address <br />Telephone Number (optional): <br />Committee Name <br />Name of Committee Treasurer <br />Committee Mailing Address <br />Telephone Number (optional): <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending Balance from previous report <br />Line 2: Total receipts this period (page 3, line 11) <br />Line 3: Subtotal (line 1 plus line 2) <br />Line 4: Total expenditures this period (page 5, line 14) <br />Line 5: Ending Balance (line 3 minus line 4) <br />Line 6: Total in-kind contributions this period (page 6) <br />Line 7: Total (all) outstanding liabilities (page 7) <br />Line 8: Name of bank(s) used: <br />1) L 'It. 'Ir 1- <br />32-b Set <br />(9- <br />c 4&b - -11`4.)\- <br />Affidavit <br />`,wf <br />Affidavit of Committee Treasurer: <br />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 <br />activity, including all contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign <br />finance activity of all persons acting under tit ori or on behalf of this committee in accordance with the requirements of M.G.L. a 55. <br />Signed under the penalties of perjury: <br />(Treasurer's signature) <br />Date: <br />FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) <br />Candidate with Committee and no activity independent of the committee <br />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 <br />❑ 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, <br />incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br />Candidate without Committee OR Candidate with independent activity filing separate report <br />®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 <br />finance activity, including contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the <br />campaign finance activity of all persons acting under the authority or on behalf of this committee accordance with the requirements of M.G.L. c, 55. <br />Signed under the penalties of perjury: <br />(Candidate's signature) Date: <br />q'/� / 7 <br />