2011-12-31-Burnell-OCPF - Laserfiche WebLink

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Form CPF M 102: Campaign Finance Report Municipal Form Office of campaign and Political Finance File with City or Town Clerk or Election Commission Please print or type all information, except signatures. Fill in dates: Yet Month Dets Yew Reporting Period Beginnin r 6 . k� t d Ending 1 "�> t 9- u l! Type of report: (Check one) ��° 08th day preceding preliminary' 08th day preceding election 030 day after election -0-year -end report 0dissolution Full m of Candldate (if applicable) ( VVVNA Office sought and District Y1 ® r'� Residential Address Tel. No. (optional) C S , ^ a 1 j IL /n !� Committee Name 1° r e' rA in -:. -o Name of Commi tee Treasurer Committee Mailing Address 0 >0 � Tel. No. (optional) SUMMARY BALANCE INFORMATION: $ , i C i $ 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) Line 4: Total expenditures this period (page 3 line 14) Line 5: Ending balance (line 3 minus line 4) $ S IL 1.C-( Line 6: Total in -kind contributions this period (page 4) S Line 7: Total (all) outstanding liabilities (page 4) $ � ` d Line 8: Name of bank(s) use �`t �� k- AfAdavit of Committee Tressumr. period I certify that I have examined this report including attached schedules and it i4 to the bas of my o knowledge and belief; a true and compile statement of alt eampahe Srnaom act including all contributions, loam, receipts, ex pmdiWra. disbursernents, in kn►d ccontributions and liabilities for shier rcportirrg p perod and represents t campaign finance activity o dtpersons acting under the authority or on behalf of this co n nittee in accordance with the requimnients of M.G.L. c. 33. Signed under the penalties of perjury: sign um (in FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELO AMOA of Gn411d2te: (check 1 box only) P , Cnnd IdMe with Coamnittee and two aetMty independent of the committee lda statemerd of all campaign I certify that I have examined this report inchrd:ng attadned 'W and it is, to the bed of my knowledge and belief a true and comp tnrnar►ce activity, of all persons acting under tt+e authority or on behalf of this oommittee in accordance with the requirements of M.G.L c. SS. I have not received any cootributiom, .1.,d any liabilities nor gads ary apuditt— - my behalf dring this repor ing peno ❑ car ,didate (without Committee OR Candidate with Independent activity !flint separate report I certify that 1 have etrarnirwcd this report incin:::'. g attached scbedula and it is, to the best of my knowledge and belief ; A true and eortglde staternernt of all pmpaign ex finance activity, including Contributions, loaner, receipts patditurea, dislnurse:rnanfs, m ku:d contribution and liabilities for this reporting period and represents the campaign fnw►ce 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. /� /7 / f Signed under the penalties of perjury: / /.- y 'Dam signature (in ink) -