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CPF ID#: <br /> (For Ogee Use Only) <br /> Form CPF 101: STATEMENT OF ORGANIZATION <br /> CANDIDA'TE'S COMMITT'EE <br /> Commonwealth f F, a c, Office of Campaign and Political Finance <br /> of Massachusetts <br /> I ile with: Director (617)979-8300 I(800)462-OCPF <br /> Office of Campaign and Political Finance ocPf@cpf.slatc.ma•us <br /> One Ashburton Place,Room 911,;BostM/102108 www.mass,govlocpf <br /> NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amended,of the organization of a <br /> candidate's committee as follows: <br /> CAr DEDATE: T+irstName: Melanie Middle Initial: Last Name:Thompson <br /> Residential Address: 360 Lowell St <br /> City/State/.Zip: Lexington MA 02420 <br /> Email Address: melaniethompson2020@gmail.com <br /> Party Affiliation:(if applicable) Phone M 7818627073 <br /> OFFICE SOUGHT/PURPOSE: <br /> Title: Member- Planning Board <br /> District: <br /> COMMITTEE: Name of Committee: Committee to Elect Melanie Thompson <br /> (The name of the connnittee must include the candidate's last name) <br /> Committee Mailing Address: 8 Hancock Avenue <br /> City I State I Zip: Lexington MA 02420 Phone 0: 7812234417 <br /> OFFICERS: <br /> Chair: Larry Freeman Treasurer": Margaret Counts-Klebe <br /> Residential Address: 218 Lowell St Residential Address: 8 Hancock Ave <br /> City I State/Zip: Lexington MA 02420 City/State!Zip: Lexington MA 02420 <br /> Email: ldfree@yahoo.com Email: margck@yahoo.com <br /> Phone H: 4047837563 Phone#: 7812234417 <br /> "A public employee may not serve as treasurer of any political committee(see reverse), <br /> I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her <br /> behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign finance activity for a period of six years from the date of <br /> the relevant election. <br /> SIGNED UNDER THE PENALTIES OF PERJURY: Date; (12,1D <br /> ........ Candidate's signature <br /> I hereby accept the office of Treasurcr of the above-named committee.I affirm that I am not a public employee as defined by M.G.L.c.55,s. 13,I understand <br /> that: 1)1 am subject to certain duties and liabilities under M.G.L.c.55,including the timely filing of campaign finance reports and keeping detailed accounts <br /> and records of all campaign finance activity for a period of six years from the date of the relevant election;2)if after my acceptance of this office I become an <br /> appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political <br /> committee organized on his/her behalf. <br /> SIGNED UNDER THE PENALTIES OF PERJURY: Date: <br /> Treasurer s;signature <br /> I hereby accept the office of Chair of the above-nam7;5z� <br /> SIGNED UNDER THE PENALTIES OF PERJUR ` <br /> l C� <br /> Date_ <br /> hair's sign <br />