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Form CPF M101 BQ: STATEMENT OF ORGANIZATION <br /> BALLOT QUESTION COMMITTEE <br /> MUNICIPAL FORM <br /> Commonwealth Office of Campaign and Political Finance <br /> of Massachusetts <br /> File with: City/Town Clerk or Election Commission <br /> NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,of the organization of a ballot question <br /> committee as follows: <br /> 1. Name(See note 1): Quiet Clean Lexington <br /> 2. Committee mailing address: 66 Harding Road <br /> City/State/Zip: Lexington MA 02420 <br /> E-mail Phone#: 781-861-1929 <br /> 3. Purpose/spccif ic issues To endorse via referendum the adoption of Article 10 at the Lexington 2021 Special Town Meeting. <br /> and interests(See note 2): The interests of the officers and anticipated donors include reducing pollution, noise, and emissions <br /> from landscape maintenance equipment. The officers have no financial interest in the referendum. <br /> 4. Topic of question& Whether to approve the adoption of Article 10 regarding landscape maintenance equipment, <br /> question no.,if known: lincluding leaf blowers. Question number not known at this time. <br /> 5. This committee is one): M support or E] oppose the question, <br /> 6. 0 MiCERS: <br /> Chairman: Archana Dayalu Treasurer*: Charles Wyman <br /> Residential Address:26 Cottage Street Residential Address: 66 Harding Road <br /> City I State/Zip: Lexington MA 02420 City/State/Zip: Lexington MA 02420 <br /> Phone#: 734-755-5442 Phone,4: 781-861-1929 <br /> *A public employee may not serve as treasurer of any political committee(see reverse). <br /> Other Officer/Title: Daniel Koretz/Vice-Chair Othvi-Officer/Title: <br /> Residential Address: 10 Hayes Lane Residential Address: <br /> city/State/zip: Lexington MA 02420 City I State/Zip: <br /> Phone M 781-861-9548 Phone#7 <br /> (Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,if any,) <br /> The chairman and treasurer of a political committee should be aware that provisions of M.G.L. c. 55 specify that each treasurer of a political <br /> committee shall keep and preserve detailed accounts,vouchers and receipts for a period of six years from the date of the relevant election. <br /> Chapter 55 also specifies that no expenditures shall be made for,or on behalf of,a political committee without the authorization of the <br /> chairman or treasurer,or their designated agents;and,that all funds of a political committee shall be kept separate from any personal funds of <br /> any officers,members or associates of such committee. <br /> I hereby accept the office of Chairman of the above-named committee. <br /> SIGNED UNDER THE PENALTIES OF PERJURY <br /> Date: <br /> Chairman's sign <br /> I hereby accept the office of Treasurer of the above-named committee.ra�ffnrm.that I am not a public employee as defined by M.G.L.c,55,s, 13.1 understand <br /> that: 1)1 am subject to certain.duties and liabilities under M.G.L,c.55, ctuding the timely filing of campaign finance reports and keeping detailed accounts <br /> and records of all campaign finance activity for a period of six years from the date of the relevant election;and 2)if after my acceptance of this office I <br /> become an appointed public employee,I must resign this position and notify OCPF of my resignation. <br /> SIGNED UNDER THE PENALTIES OF PERJURY: <br /> Cq /� <br /> Date: f4J0/-;Z1 <br /> Treasurer's signature U <br />