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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 <br /> File wiih: Ci or Town Clerk or Election Commission <br /> hill in Reporting Period dates. Beginning Date: Ending Date: 1 <br /> Type of Report- (Check one) <br /> [] 8th day preceding preliminary d8th day preceding election ❑ 30 day after election ❑ year-end report ❑ dissolution <br /> /l1 <br /> Candidate Full Name(if applica le) Committee Naine <br /> office Sought and istrict Name of Committee.Treasurer <br /> t <br /> Residential Address Committee.Mailing Address <br /> Tele hone Num. er(n tional <br /> Telephone]`lumber(optional): P P ) <br /> i r�r� s� a <br /> SUMMARY BALANCE INFORMATION: <br /> Line I: Ending Balance frorn previovis report <br /> D <br /> Linen: Total receipts this period(page-3,line 11) <br /> Lime 3: Subtotal <br /> line 1 plus line 2 <br /> f <br /> Line 4: Total expenditures this period(page 5,line.14) r i <br /> Line 5: Ending Balance(line 3 minus line 4) 1 i <br /> Line 6: Total.in-kind contributions this period(page 6) ' <br /> Line 7: Total(all)outstanding liabilities(page 7) <br /> Line 8: Name ofhank(s)used: &O <br /> Affidavit of Central <br /> Treasurer: <br /> 1 certify that F have examined this report including attached schedules and it is,to the best of my knowledge and belief,a true and complete statement oral]campaign finance <br /> activity,including all cohtributions;loans,receipts,expenditures,disbursements jn-kind contributions and liabilities for this reporting period and represents the campaign <br /> 1 <br /> finance activity of all persons acting under the authority or art behalf of this committee in accordance.vith the requirements,of M.G.L.c..35. <br /> Signed tinder the penalties of perjury: _ (Treasurers signature) l7tt <br /> FOR CANDIDATR FILINGS ONLY: Affidavit or candidate;(chec(I box Only) <br /> i' <br /> i <br /> Candidate with Committee and no activity Independent of the comniltice <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,.dfall persons acting under the authority os on behalf of this committee in accordance with the requirements of M.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 CSR Candidate with independent activity filing separate report <br /> I certify that I have examined ibis report including attached schedules and itis,to the'pest 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 acdng under the authority or on behalf of this committee in accordance with tho requirements of M.G.L,c.55. <br /> Signed under the penalties afperjury: l t >✓i1 i5f (Candidate's signature) Dwe- a ��a <br />