2010-12-31-Burnell-OCPF - Laserfiche WebLink

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Form CPF M 102: Campaign Finance Report i"*; E I V Municipal Form Gmce of campaign and Political F7nance 201 J, — 4 AM 8 : 4 6 .rM` t. TO W Pi LtXI �u T ON H File with: City or Town Clerk or Elation Conwtission Please print or tvoe all information, except signatures. Fill in dates: Month Date Year Month Date Yew Reporting Period Beginning_C� `z+ `� (., 1 u Ending I ',;( S ( ";In, 3 Type of report: (Check one) 08th day preceding preliminary 08th day preceding election 030 day after election 2`year -end report ❑dissolution Full Name of Candidate (if applicable) Office Sought and District Residential Address Tel. No. (optional) Tel. No. (optional) SUMMARY BALANCE INFORMATION: Line 1: Ending balance from previous report $ Line 2: Total receipts this period (page 2 line 11) $ Line 3 : Subtotal (line 1 plus line 2) $ Line 4: Total expenditures this period (page 3, line 14) $ b Line 5: Ending balance (line 3 minus line a) $ ) i ---------------------------------- Line 6: Total in -kind contributions this period (page a) $ C Line 7: Total (all) outstanding liabilities (page a) $ S `1 , ;VU Line 8: Name of bank(s) use ) 4ki— L-- Affidavit of Cmmnnittee Treasurer. I certify that 1 have examined this report including attached sche&les and it is, to the best of my knowledge and belief, a true and complete statement of all ampa:gn finance activity, including all contributions, loans, receipts, exPerditures, disbursements, tit." contributions and liabilities for this reporting Period and represents the campaign f of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. o, 5 Signed under the penalties of perjury: l t signature (in ink) FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW) Af 11 vit of Candidate: (check I box only) of the committee andidate with Committee and no activity independent I catify that I have examined this report including attached schedules and it is to the best of my knowledge and belied a true and complete s 1 have of all campaign finance activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L a SS. I have not received any contributions, marred any liabilities nor made any expenditures on my behalf during this reporting period. Candidate without Commtttea OR Candidate with Independent activity filing separate report I certify that I have examined this report including attached schxdules and it is, to the best of my knowledge and belief; awe and complete statement of all campaign finance activity, including contributions, loans, rcoetpts, expenditures, d:sbursemcttts, in-kind contributions and liabilities for this reporting period and represents the campaign fmanceactivity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G..l- c. SS. A2 s Signed under the penalties of perjury: ( / f / /� 0 U Committee Name Name of Committee Treasurer � . Committee Mailing Address 6SL al 4-- - (- 5 - ") k 1 4Y t/ Date signature (in ink)