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Form CPF M 102 -0: Campaign Finance Repo '` <br />r i <br />Municipal Form <br />Office of Campaign and Political Finance 201 I 0 PM 12' 53 <br />Casawewal(b <br />of Msusachusetls <br />i ( <br />City or Town of: Lp y l viql d t- t LEXINGTON VIA <br />Please print or type all information, except signatures. <br />�' Te," <br />Fill in dates: <br />Month <br />Day <br />Year Month Day Year <br />Reporting Period Beginning <br />U- .4i y� <br />J <br />'�) o i c) Ending a i — ?) C) <br />Type of Report: (Check One) <br />n 8th day preceding 8th day preceding election n 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. 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 />CJ <br />