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Form CPF M 102: Campaign Finance Report <br />, r <br />P l� P , <br />Municipal Form ��F! L ! g ar 2: r; <br />Once of campaign and Polittcat Finance <br />1ata..d,a..ea L E <br />File with: <br />City or Town Clerk or Election Commission <br />Please print or type all information, except signatures. <br />Fill in dates: Month Dde Y ew Month Dete Y ew <br />Reporting Period Beginnin P� ,C,;? ''2 0 / Ending 17PF f b ✓ 17— <br />Type of report: (Check one) <br />08th day preceding preliminary 08th day preceding election 030 day after election -Elyear�nd report ® lution J <br />/)-A`/ w C C 1 / C cry' <br />Full Name of Candidate (if applicable) <br />Office Sought and District <br />/ c Cw L y I/ <br />Residential Address <br />�.- ✓ ��- YC4 X14 . 7fll -,6' 9 ,V45 <br />Tel. No. (optional) <br />Committee Name <br />Name of Committee Treasurer <br />Committee Mailing Address <br />Tel. No. (optional) <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending balance from previous report $ <br />Line 2: Total receipts this period (page 2 line 11) $ f <br />Line 3: Subtotal pine 1 plus line 2) $ <br />Line 4: Total expenditures this period (page 3 line 14) $ 7 !" <br />Line 5: Ending balance pine 3 minus line 4) $ <br />---------------------------------- <br />Line 6: Total in -kind contributions this period (page 4) $ <br />Line 7: Total (all) outstanding liabilities (page 4) $ <br />Line 8: Name of bank(s) used - 7-tems <br />Affidavit of Committee Treasurer. <br />1 artify that I have examined this report including attached schedules and it is, to the lest of my knowledge and belief, a true and complete dateme:n of all campaign <br />finance activity, including all contributions, loans, receipts, expenditures, disbursements, ire -kind contributions and liabilities for this reporting period and represents the <br />fm <br />campaign aMCe V" of all acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. SS. <br />r Signed under the penalties of perjury: / I/// /J ' <br />Treseorer's signature <br />: (CANDIDATE MUST SIGN BELOW) <br />Afndavit of Candidate: (check 1 boa only) <br />❑ Candidate with Committee and no activity independent of the committee <br />I certify that I have examined this report including attached schedules and it is, to the bed of my knowledge and belief a true and complete statement of all campaign <br />finance activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.O.L. e. 33, h have not received any <br />oomributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br />❑ Candldate without Committee OR Candidate with Independent activity Ming separate report <br />1 certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief a true and complete statrneM of all campaign <br />finance activity, including conlributiom loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the <br />vampai activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. S S. <br />Signed ' er the penalties of perjury: <br />Candidate signature (in ' ) ate <br />