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Form CPF M 102: Campaign Finance Report <br /> ,p <br /> b Municipal Form <br /> Office of Campaign and Political Finance <br /> Commonwealth <br /> of Massachusetts <br /> File with: City or Town Clerk or Flection Commission <br /> Fill in Reporting Period dates: Beginning Date: / Ending Date: Z 3 f <br /> Type of Report: (Check one) <br /> 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year-end report PTdissolution <br /> PJ e <br /> Candidate Full Nante(if applicable) Committee Name <br /> office Sought and District Name of Committee Treasurer <br /> Residential Address Committee Mailing Address <br /> Telephone Number(optional): 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) r <br /> Line 4: Total expenditures this period(page 5, line 14) <br /> :. <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) N' <br /> Line 8: Name of bank(s)used: <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,unkind contributions and liabilities for this reporting period and represents the Campaign <br /> finance activity of all persons acting tinder the authority or on behalf of this contntiuee in accordance with the requirements ofM.G.L.c.55. <br /> Signed under the penalties of perjury: <br /> (Treasurers signature) Date: <br /> hOR[ANDIDATI;PILI ONLY: Affidavit of Candidate:(check!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 azul 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 IOR 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 illy knowledge and belief,a trueand complete statement of all campaign <br /> LVJ 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 in accordance with the requirements of M.G.L.c.55. <br /> llate: Z <br /> Signed under the penalties of perjury: (Candidate's signature) <br />