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Form CPF M 102: Campaign Finance Report
Commonwealth
of Massachusetts Office of Campaign and Political Finance
File with:
City or Town Clerk or Election Commission
Reporting Period: Beginning: 1/1/2012 Ending: 1/4/2013
2013 J,r� 15 1,RH2Q3e33
L
Type of Repo Dissolution
Charles Hornig
Full Name of Candidate
Planning Board /Lexington
office Sought/ District
75 Reed St
Lexington, MA 02421
Residential Address
Char Hornig for Plannin Board
Committee Name
Thomas Griffiths
Name of Committee Treasurer
7 Volunteer Way
Lexington, MA 02420
Committee Address
SUMMARY BALANCE INFORMATION
Ending balance from previous report: $328.98
Total receipts this period: $50.00
Subtotal: $378.98
Total expenditures this period: $378.98
Ending Balance: $0.00
Total inkind contributions this period: $0.00
Total outstanding liabilities: $0.00
Name of Bank Used: TD Bank
Affidavit of Committee Treasurer:
I 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 statement of all campaign finance activity including all contributions, loans, receipts,
expenditures, disbursements, inkind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the authority or on behalf of this committee in accordance with the
requirements of M.G.L. c. 55.
Signed under the penalties of erjury:
Treasurer's signature (in Ink) V I Date
Affidavit of Candidate (check 1 box only) :
c I andidate with Committee and no activity independent of the committee
certify that I have examined this report, and attached schedules and it is, to the best of my knowledge and belief, a
true and complete statement of all campaign finance activity, of all persons acting under the authority or on behalf of
this committee in accordance with the requirements of M.G.L. c. 55. 1 have not received any contributions, incurred
any liabilities nor made any expenditures on my behalf during this reporting period.
Candidate without Committee OR candidate with independent activity filing separate report.
❑ I certify that I have examined this report and attached schedules and it is, to the best of my knowledge and belief,
a true and complete statement of all campaign finance activity including contributions, loans, receipts, expenditures,
disbursements, inkind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the authority or on behalf of this committee in accordance with the
requirements of M.G.L. c. 55.
Signed under the p enal tie per' ry
Date
Candi a e's sig re (in ink)
Schedule Ao Receipts
M.G.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts
over $50 in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
itemize those receipts over $50. In addition, the occupation and employer must be reported for all persons
who contribute $200 or more in a calendar year.
Date Name and Residential Address Amount Occupation and Employer
Total Itemized Receipts: $0.00
Total Unitemized Receipts: $50.00
Total Receipts: $50.00
Charles Hornig for Planning Board A -1
Schedule Ba 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 over $50 and under may be added together from committee records,
and reported on line 13.
Date Name and Address
Amount Purpose
6/20/2012 Bank Chk - Friends of The Council
$139.49 Donation of 1/2
On Aging
Balance
1475 Massachusetts Ave
Lexington, MA 02420
6/20/2012 Bank Chk - PTA Scholarship Fund
$139.49 Donation of 1/2
5 Mohawk Dr
Balance
Lexington, MA 02421
4/30/2012 TD Bank
$25.00 Account Maintenance
1840 Massachusetts Ave.
Lexington, MA 02421
5/31/2012 TD Bank
$25.00 Account Maintenance
1840 Massachusetts Ave.
Lex M A 02421
Total Itemized Expenditures: $328.98
Total Unitemized Expenditures: $50.00
Total Expenditures: $378.98
Charles Hornig for Planning Board B -1