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Please print or type all information, except signatures. <br />Fill in dates: Month <br />Day Year Month <br />Day <br />Year <br />Reporting Period Beginning ( <br />( / 0 Endin <br />[ L <br />i p <br />Type of Report: (Check One) <br />8th day preceding 8th day preceding election L' 30th day following election ❑ 20th day of January <br />preliminary /primary (Town or Special) (Year -End Report)' <br />Pursuant to M.G.L., Chapter 55: <br />1. 1 certify that I am a candidate for or hold Municipal Office. <br />2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this <br />reporting period, and do not have a campaign fund in existence. <br />1 1 certify that I do not have a political committee. <br />N <br />