2011-04-07-Embry-OCPF - Laserfiche WebLink

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Form CPF M 102: Campaign Finance Report Municipal Form A a utieal Fhnance o f .�. Vince of Campaign an o ri A R of Ma adu.an r ' File with: City or Town Cleric or Election Commission 1� )'�� Please print or type all information, except signatures. Fill in dates: Maur Due v et Month DW yen Reporting Period Begin / / Ending ' :� f I f Type of report: (Check one) ❑8th day preceding preliminary 08th day preceding election 30 day after election ❑year -end report ❑dissolution ., Full Name of Candidate (if applicable) Office Sought and District Residential Address Tel. No. (optional) Committee Name Name of Committee Treasurer Committee Mailing Address 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) $_ 0 Line 4: Total expenditures this period (page 3 line 14) $ C) _ Line 5: Ending balance (line 3 minus line 4) $ —C) ---------------------------------- Line 6: Total in -kind contributions this period (page 4) $ Line 7: Total (all) outstanding liabilities (page 4) $ Line 8: Name of bank(s) used Affidavit of Committee Treasurer. I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign flounce activity, including all contributions, loans, receipts, expenditures, disbursements, k kind contributions and liabilities for this reporting period and represents the 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. c. 33. Signed under the penalties of perjury: Treasurer's siputure (in ink) Date FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW) Affidavit of Candidate: (check I box only) C Candidate with Committee and no activity independent of the committee I ccr* that I have examined this report including attached schedules and it is, to the best of my knowledge and belie; a true and complete statement 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. c. SS. I have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. O Candidate without Committee OR Candidate with Independent activity thing separate report I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief; a true and complete statem A of all campaign finance activity, including contributions, 1 receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign fuu oe activity of all per:orta under the authority or on behalf of this conuruttee in accordance with the requirements of M.G.L. c. 35. Signed under the penalties of perjury: Candidate siowture (in ink) 11 Date