HomeMy WebLinkAbout2012-12-31-Burnell-OCPF-DissolutionForm CPF M 102: Campaign Finance Report
Municipal Form i
� Office of Campaign and Political Finance VED
1013 JA 10 PM 3 09
Commonwealth
of Mnsgachngattq
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File with: ra Ve ToV
QerK% Election Commission
Fill in Reporting Period dates: Beginning Date: 1/1/2012 Ending Date: L /12A JA
Type of Report: (Check one)
❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year -end report ❑X dissolution
George Burnell
Candidate Full Name (if applicable)
Selectman
Office Sought and District
George Burnell for Selectman
Committee Name
Ann Redmon
Name of Committee Treasurer
SUMMARY BALANCE INFORMATION:
Line 1: Ending Balance from previous report
Line 2: Total receipts this period (page 3, line 11)
Line 3: Subtotal (line 1 plus line 2)
Line 4: Total expenditures this period (page 5, line 14)
Line 5: Ending Balance (line 3 minus line 4)
161.92
161.92
�_- 161.92
Line 6: Total in -kind contributions this period (page 6)
Line 7: Total (all) outstanding liabilities (page 7) 377.78
Line 8: Name of bank(s) used: I Sovereign Bank
affidavit of Committee Treasurer:
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
ictivity, including all contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the authority or - half of this committee in accordance with the requirements of M.G.L. c. 55.
gned under the penalties of perjury: (Treasurer's signature) Date:
Affidavit of Candidate: (check 1 box only)
Candidate with Committee and no activity independent of the committee '
n 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
tJ 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. I 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 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 contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the
campaign finance activity of all persons acting un th authority or on h f of this committee in accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury: (Candidate's signature) Date:
SCHEDULE B: EXPENDITURES
Al. 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 itemi.;e those over $50. Expenditures $50 and under may be added together,
Groin connnittee records, and reported on line 13.
(A "Schedule B: Expenditures" attachment is available to complete, print and attach to this report, if additional pages are required to
report all expenditures. Please include your committee name and a page number on each page.)
Date Paid
12/12/2012
To Whom Paid
(alphabetical listing)
George Burnell
Address
4 Eaton Road, Lexington, MA
02420
Purpose of Expenditure
Final Card
Amount
161.92
Line 12: Total Expenditures over $50 (or listed above)
161.92
Line 13: Total Expenditures $50 and under* (not listed above) I
Enter on page 1, line 4
Line 14: TOTAL EXPENDITURES IN THE PERIOD 161.92
T it you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemized
above. Page 4
SCHEDULE D: LIABILITIES
M.G. L. c. SS 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
2/27/2007
To Whom Due
George Burnell
Address
E0242:0 Road, Lexington, MA
Purpose
Final Card
Amount
3
EE:
Enter on page 1, line 7
Line 18: TOTAL OUTSTANDING
LIABILITIES (ALL)
Page 7