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Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />orrice or campaign and Political Finance <br />Cc®�onwcdq , <br />of Meaecburettr <br />City or .Town of. c X / 1�a _ /J <br />Please print or type all information, except signatures. <br />Fill in dates: Month Day Year Month Day Year <br />Reporting Period Beginning I t - Z. 0 Ending 1 2— C <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 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 />DATE <br />1. SIGNATURE <br />Signed under the penalties of perjury <br />II, RESIDENTIAL ADDRESS <br />(Street and Number) <br />III, OFFICE SOUGHT <br />/ <br />`fir Zt <br />> ' <br />^� 1 <br />11/97 <br />2 <br />