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Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />commonwaltb <br />of Muutbr�ttp <br />i <br />City or Town of: ��}'�1 Candidate ��;1 ��1�� �� �`� O f fice <br />Please print or type all information, except signatures. <br />Fill in dates: Month <br />7 <br />Day Year <br />Kopth Day <br />�t, <br />Year <br />Reporting Period Beginnin <br />{�, _ <br />Ending Fv� r� 2 <br />r;7� �r <br />Type of Report: (Check One) <br />8th day preceding 8th day preceding election "30 day following election E 20th day of January <br />preliminary/primary (Town or Special) (Year -End Report)' <br />Pursuant to M.G.L., Chapter 55: <br />1. 1 certify that 1 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 />0 <br />