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r _ IL A Municipal Form 0 ke of Campaign and Political Fitrance Commonwealtht .q 22 "` 1 of Massaehusctts `� " � t �) Dile with: City or Town Clerk or Election Commission Fill in Reporting Period dates: LE ;' 't a `x IU c�t c c+r trading Date: Type of Report: (Check. one) ❑ Sth day preceding preliminary ❑ Sth day preceding election ❑ 30 day aper election year-end report ❑ dissolution (✓ l_ �?.1r"�r =i Z= i! Pe r xr Candidate Ful]'Nonte(if applicable) Committee NameL- r, Office Sought and Di5lriel Mame of Committee Treasurer - c - r � ltG � I ,t 1 -1 f-3 i�3 r t t__ _ i:_7. t;/r f r 1' �; �> ;'j �,_ = Residential Address Committee Mailing Address I'cicphonc lumber(optional): fetcphone Number(optional): SUIVIMARY BALANCE INFORMATION: Line I: Ending Balance from previous report J �� Line 2: Total receipts this period (page 3, line 1 1) Line 3: Subtotal (line 1 plus line 2) 2-0 Line 4: Total expenditures this period (page 5, line 14) Lane 5: Ending Balance(line 3 minus line 4) Line 6: Total ire-kind contributions this period(page 6) Line 7: Total (all) outstanding liabilities (page 7) Line 8: Name of bank(s) used: ('. ; Z F'-/')=3 fj A-,mss Affidavi(of Connmittee Treasru•er: I certify Haat I have e.xamined this report tnckad'€ng atlached sche(itiles and it is,to the best of my katowledge and belief,a true and complete statement of all campaign finance activity,including all contributions,loans,receipts,expenditin es,disbit senents,in-kind contributions and Liabilities for this repotting period and represents the campaign finance activity of all persons acting tulder the autliority or on behnit-of this committee in accordance with the requirements of M_G.L,c.55_ z Signed under the penalties of perjury: -,— -- -�� ' {'I reasttrer s signature) D71te: ZQ J FOR CANDIDATE FILINGS ONLY, affidavit of Candidate:(check t box only) Candidate with Comndttec and no activity indepeudcut of the committee I certify that 1 have examined this report including attached schedules and it is,to the hest of my knowledge and belief,a true and complete statement of all campaign finance activity,of all persons acting tutdcr the authority or on behalf of this committee in accordance with the regsritetnenis of M.G.L.c.55, 1 have not received any contributions, incltrrcd any liabilities nor made any cxpendintres oil airy behalf during this reporting peaiod. Candidate without Committee OR Candidate with independent activity filing separate report ❑ I certify that I have examined thus report including attached schedrtles and it is,to the best of my knowledge and belief,a true and complete statement of alI campaign final€ce activity,including contributions,loans,receipts,expenditures,disbirrsemen€s,in-kind contributions and liabilities for this reporting period and represents the c<9mpaign finance activity of all persons acting tinder the authority or on behalf of this committee in accordance with the regisirentcots of M.G.L.c.55.