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or CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Commonwealth of Massachusetts File with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: Ending rete: Type of Report: (Check one) 8th day preceding preliminary 8th day preceding election [j�30 day after election year-end report dissolution 10 Z14 Candidate Full Name(if applicaele) Committee Name Office Sought and Distrief Name of Committee Treasurer ItIl Residential Address Committee Mailing Address Telephone Number(optional"): 1 '7,Vl-- 211k- A�r,36 Telephone Number(optional) SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period (page 3, line 11) 0 Line 3: Subtotal (line I Plus line 2) 0 Line 4: Total expenditures this period(page 5, line 14) ®®_�_ m 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) Line 8: Name of bank(s)used: /U Affidavit of Committee Treasurer: I certify that I have examined this report including attached schedules and itis,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 ofthis committee in accordance with the requirements ol`M.G.L.C.55. Signed under the penalties of perjury: &Zr (Treasurer's signature) Date: FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(check I box only) Candidate with Committee and no activit, y independent of the committee MI 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,of all persons acting under the authority or on behalf ofthis committee in accordance with the requirements ofM G.L.c.55. 1 have not received any contributions, incurred any liabilities nor made any expenditures on roy behalf daring,this reporting period. Candidate without Committee 011 Candidate with independent activity filing separate report I cerfify 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 tJ finance activity,including contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents the campaign finance activity ofall persons acting tinder the authority or on belratjfa�this committee in accordance with the requirements ofM.G.L.c.55. 2 Signed Linder the penalties of perjury: —(Candidate's signature) Date: Q iature) A110