HomeMy WebLinkAbout2012-12-31-Kelley-OCPFForm CPF M 102: Campaign Finance Report
Municipal Form
O1nce of Gantpalgn and I'o!lUcai Fhrance
d Ma,u
Filo with;
City or Town Clerk or Election Commission
Please print or type all information, except signatures.
Fill in dates Mash Dap Yea Montt pate Yea
Reporting Period Beginn Q c'3 l 2. Ending ► l
Type of report: (Check one)
08th day preceding preliminary 08th day preceding election 0130 day after election ear -end report [dissolution
Full N me of Candidate (if a pplicable)
�Adticc Sought and A rict (�
UC l t t � C� (` E S l`
_);residential Address
1
Tel. No. (optional)
Committee Name,
, -1 N c) t4 L5.1
Name of Committee Treasurer
Committee Mailing Address
Tel. No. (optional)
SUMMARY BALANCE INFORMATION: r I c
Line 1: Ending balance from previous report $_JS'
Line 2: Total receipts this period (page 2, line 11) $ I
Line 3: Subtotal (line 1 plus line 2) $
Line 4: Total expenditures this period (page 3, line 14) $�
Line S: Ending balance (lute 3 minus line 4)
Line 6: Total in -kind contribution <s this period (pegs 4> $ C
Line 7: Total (all) outstanding liabilities (page 4) $ t"')
Line 8: Name of bank(s) used Lc =e' t tv e - linn '
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Affidavit of Conu dtta Treasurers
I certify that I have examined this report including an"W schedules and it is, to rho beg of my knowledge and belief, a true and complete statowd of all campaign
finance aNvity, including all contributions, loans, receipts, expenditures, di>burxernaus, in -kind contributions and liabilities for this reporting period and represaa the
campaign linan o activity of ail persons acting under the authority or on behalf of this owanittoe in accordance with the reluiremenu of M.O.L c. SS.
Signed under the penalties of perjuryt
do
A- t_tn
FOR CANDIDATE FILINGS ONLY: (CANDIDATE MUST SIGN BELOW)
davit of candidate: (dteek 1 box only)
LZ Candidate with Committee and no activity hndependent of the eonunittee
I ratify that I have examined this report including atuehed schedules and it is to the best of my knowledge and ballet; a true and complete statenwo of all campaign
finance activity, of all persons acting under the autiority or on behalf of thin committee in accordanoe with the requirements of M.O.I.. a. 1$. 1 have not recaivod any
oortributions, bwunvd try liabilities nor made any expenditures on my bahaif during this reporting period.
Q Candidate Without Committee 0 Candidate with independent activity Ong separate report
I certify that I have examined 04 retort including attached schedules and it Is, to the best of my knowledge and belief: a true and compleia s Miont of all campaign
finame activity, including contributions, loans, receipts, expenditures, disbursernen* "ind contributions and liabilities for this reporting period and reprowo the
campaign activity of aD pens" acting under the authority or on behaif of this eonunittee in accordance with the requirements of M.O.L c. 33.
Signed under the penalties of perjury;
� r a
Candidate si ) Date
SCHEDULE A: RECEIPTS
ti1,G.L. c, 55 requires that the name and residential address be reported, in alphabetical order, for all receipts
aver $50. in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
N,+niixe those receipts over ss0. In addition, the ucwwpatlon and entplvyer must be reported for all persons who
e(gliribute ,$200 or more in a calendar year,
1.1 page may be copied if additional pages are required to report all receipts. Please include your committee name and a page
be n each a e
ttllnl C o
Date
Iteceived
p g .
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
® j
1�
Line 9: Total receipts in excess of $50 (or listed above)
U Enter on page 1, line 2
0 IA nU. 1A 4- 1...4. nnl., fhn¢p rP[ -Ante not itemize
Line 10: Total receipts $50 and under* (not listed above)
Line 11; TOTAL RECEIPTS IN THE PERIOD
_ e__. _.i_ _ AL -- f_ f1...,
n i :
# if you have it e mized rec eipts o f S50 and under tncluUC uL U IL1 III IIbIG 7. I'AM, ,v altv4lu .uw#— vary ...- - ....... - I
above, Page 2
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SCHEDULE B: EXPENDITURES
M.G.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 in a reporting period
Committees must keep detailed accounts and records of all expenditures, but need only itemize those over $50.
Expenditures $50 and under may be added together, from committee records, and reported on line 13.
Thus page may be copied if additional pages are required to report all expenditures. Please include your committee name and a page
number on each page.
Date Paid
To Whom Paid
(alp listing)
Address
Purpose of Expenditure
Amount
5
yt,
Y
Enter on page 1, line 4
Line 12: Expenditures over $50
Line 13: Expenditures $50 and under*
Line 14 :TOTAL EXPENDITURES
x �
r l
*If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not
itemized above Page 3
SCHEDULE C: "IN- KIND" CONTRIBUTIONS
Please itemize contributors who have made in -kind contributions of more than'$50, In -kind contributions $50 and under may be
added together from the committee's records and included in line 16,
Date
From Whom Received*
Residential Address
Description of
Value
Received
Contribution
X
Enter on page 1, line 7
Line 18: OUTSTANDING LIABILITIES (ALL)
.
cr7
Dine 15: I n -kind over $50
Line 16: In -kind $50 and under
Line 17: Total In -kind
,dam
Enter on page 1, line 6
* If an In -kind contribution is received from a person who contributes more than $50 in a calendar year, you must report the name
and address of the contributor; in addition, if the contribution is $200 or more, you must also report the contributor's occupation and
employer,
SCHEDULE D: LIABILITIES
M,G,L. c. 55 requires committees to report ALL liabilities which have been reported previously and are still outstanding, as well as
those liabilities incurred during this reporting period,
Date
Incurred
To Whom Due
Address
Purpose
Amount
Enter on page 1, line 7
Line 18: OUTSTANDING LIABILITIES (ALL)
This page may be copied if additional pages are required to report all activity. Please include your committee name and a page
number on each page, L s'� printed on recycled paper Page 4