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Form CPF M 102-0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />of Mwuhuxtu <br />City or Town of <br />Please print or type all information, except signatures. <br />Fill in dates: Month <br />Day <br />Year <br />Month <br />Day, <br />Year <br />Reporting Period Beginning <br />Ending <br />/ -K <br />Type of Report: (Check One) <br />8th day preceding 8th day preceding election 0 30th day following election 20th day of January <br />prelim inary/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. 1 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. 1 certify that I do not have a political committee. <br />DATE <br />1. SIGNATURE <br />Signed under the p <br />h .0nalties of perjury <br />11. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III. OFFICE SOUGHT <br />Uj <br />0 <br />""I <br />j <br />0 X <br />�77 <br />11/97 <br />0 <br />