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Form CPF M 102: Campaign Finance Report <br /> Municipal Form <br /> Office of Campaign and Political Finance <br /> Commonwealth � <br /> of Massachusetts lit l i'AH '2 2 r`ihli 7- t_1 4 <br /> File with: City or Town Clerk or Election Commission <br /> Fill in R,portin 1?01010d dhtes ' Beginning Date: Ending Date: q <br /> EXI�46 i u � l a <br /> Type of Report: (Check one) <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year-end report ❑ dissolution <br /> Candidate hull Name(if applicable) Committee Name <br /> Office Sought and District Name of Committee T�Fpsufer <br /> Residential Address Committee Mailing ti:'ddtess em t <br /> Telephone Number(optional): ` r )b L Telephone Number(optional): <br /> ------------- <br /> SUMMARY BALANCE INFORMATION: <br /> �r <br /> Line 1: Ending Balance from previous report <br /> Line 2: Total receipts this period(page 3, line 1 1) <br /> Lime 3: Subtotal(line 1 plus line 2) " , p <br /> Line 4: Total expenditures this period(page 5, line 14) �e'` <br /> Line 5: Ending Balance(line 3 minds 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 /> 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 the zln ority or;�balfofthis coquitittee in accordance with the requirements ofM.G.L.c.55. <br /> Signed under the penalties of perjury: (Treasurer's signature) 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,ofall persons acting under the authority or on behalf of this committee in accordance with the requirements oflvl.G.L.c.55. 1 have not received any contributions, <br /> incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br /> Candidate without Committee DR Candidate will►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�r on behalf of this committee in accordance with the requirements of M.G.L.c.55. <br /> Date: f J <br /> Signed ander the penalties of peijiu•y: -�- � '` (Candidate's signature) <br />