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t, <br />1 =- 5 <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />office of Campaign and Political Finance <br />City or Town of- s Candidate 1Z <br />Please print or type all information, except signatures. <br />N A A ct Office <br />'ill in dates: Month <br />Day <br />Year <br />Month <br />Day Year <br />teporting Period Beginning Ei-LIS <br />1-`7 <br />`2, O I Z . <br />Ending 23�� <br />type of Report: (Check One) <br />❑ 8th day preceding El 8th day preceding election El day following election El 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 />0 <br />