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REMO <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />CesaenweellL • , <br />. of Muuc6uiep� <br />City or Town of: i— r->< / to C' 0/`° <br />Please print or type all information, except signatures. <br />Fill in dates: <br />Month <br />Day <br />Year <br />Month <br />Day <br />Year <br />Reporting Period Beginning <br />I <br />Ending 1 <br />1 <br />1 <br />Type of Report: (Check One) <br />8th day preceding 8th day preceding election C 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 1 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 />11/Y / <br />Cd <br />