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Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />Commonwealth <br />of Maaaachmellf <br />N <br />City or Town of: kc Y f y'lC C V r <br />XC) r <br />Please print or type all information, except signatures. 1 <br />G7 l <br />'ill in dates: Month Day Year Month Day 0 ear 1 . <br />teporting Period Beginning _jLz, ,l d 2 - 0 Ending t - :� 0 rfI <br />co <br />cz <br />'ype of Report: (Check One) <br />8th day preceding 8th day preceding election El 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 />I. I 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 />3. I certify that I do not have a political committee. <br />DATE <br />1. SIGNATURE <br />Signed under the penalties of perjury <br />II. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III. OFFICE SOUGHT <br />W� <br />I <br />� 4 .S o �'� / ��� <br />A 0 I e s' <br />11/7/ <br />iJ <br />