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Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Commonwealth W DEC ; #rte E of Massachusetts File with: CitV or To"' "Clqrr:Election Commission Rill in Reporting Period dates: Beginning Date: Mc,,V�� t �c . Ending Date: Type of Report: (Check one) ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election year-end report E] dissolution Candidate Full Name(if applicable) Committee Name "A tN 71 NA\,(% L1oskC: � �a Office Sought and Distric Name of Committee Treasurer f iz ._ t'N\') . �t ?M'{ ( (fit AU Cz L ice-T c�_ 1, � `�I � L rv1_�{ Residential Address Committee Mailing Address Telephone Number(optional): ; (} 0 Telephone Number(optional): SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report '2_. Line 2: Total receipts this period(page 3,line 11) V 2AA ` 5ZD Line 3: Subtotal(line 1 plus line 2) `{ 01 ' 2-- Line 4: Total expenditures this period(page 5, line 14) Z Line 5: Ending Balance(line 3 minus line 4) Line 6: Total in-kind contributions this period(page 6) Line 7: Total(all)outstanding liabilities(page 7) U Line 8: Name of bank(s)used: 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 behalf of this committee in accordance with the requirements of M.G.L.c.55. �4 Signed under the penalties of perjury: ��'��'- � �J�� .�� '"` (Treasu€cessignature) Date: � Ili lot� FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(check 1 box only) Candidate with Committee acid no activity independent of the committee r l 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 �J 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. Candidate without Committee OR Candidate with independent activity filing separate report 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 committee in accordance with the requirements of M.G.L.c.55. Signed under the penalties of perjury: `' c;. ' rye ' 3�� '� (Candidate's signature) Date: l k1 j