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Form CFF M 102: Campaign Finance Rd#"dftF Pry 3:1
Municipal Form
Office of cam and Political Finance `� t� s
Camp aign L XIr"JC o s9
c..r..e..ea�
r
File with:
City or Town Clerk or Election Commission
Please print or type all information, except signatures.
Fill in dates: Marsh Date Yew Month Date Yew
Reporting Period Beginnin Sam lk cxv a% a o l Ending A W "x ®13
Type of report: (Check one)
88th day preceding preliminary 08th day preceding election 030 day after election Clyear -end report Odissolution
• ( N0.MG�/ CC N- e004—C X \h 3 . 0A C f% — k 1 t
All Name of Candidate (if applicable)
�l�ev,w 1 v 0 Lev -�v~ tin
Rice Sought and District
3L1 `-1 1- ca w e.\\
Residential Address
Tel. No. (optional)
^ ` ckv\ cL C OY- CwrCk K 04 -k't e "'k -F o r
Y��W1n� V1Pn t�
V Committee Name
S v - e-LA. Vwi
Name of Committee Treasurer
za Jou\Ac, %ft ., Ley,%.�c-rov\, uU t _oaujZ&
Committee Mailing Address
Tel. No. (optional)
SUMMARY BALANCE INFORMATION:
Line 1: Ending balance from previous report $ - ® -
Line 2: Total receipts this period (page 2 line 11) $ - G
Line 3 : Subtotal pine 1 plus line 2) $ --
Line 4: Total expenditures this period (page 3 line 14) $ 1 '
Line 5: Ending balance pine 3 minus line 4) $ GcJJ
----------------------------------
Line 6: Total in -kind contributions this period (page 4) $ VAI- (a
Line 7: Total (all) outstanding liabilities (page a) $
Line 8: Name of bank(s) used u�- otcco -k* V. ci
Affidavit of Committee Treasurer
I certify that I have examined this report including attached schedules and it is, to the bat of my knowledge and belief, a true and complete statement of all campaign
finance activity, including all contributions, loans, receipts, expenditures, disbursements. in -kind contributions and liabilities for this reporting period and represents the
campaign £mane activity of all persgas acting under the authority or on behalf of this cornmittes in accordance with the requirements of M.G.L. c. 35.
\ Signed under the penables of perjury: 1
Treasurer's siputure (in ink) e
FOR CANDIDATE FILINGS ON (CANDIDATE MUST SIGN BELOW)
Affidavit of Candidate: (check I box only)
❑ Candidate with Committee and to activity independent of the committee
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, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 35. 1 have not received any
contributions, incurred any liabilities nor nude any expenditures on my belaifduring this reporting period.
O Candidate without Committee OR Cardldate 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, disMrrsernents, in -kind cwrtributiams stud liabilities for this reporting period and represents the
campaign Stance activity of all acting under the authority or on behaWoff thiss committee in accordance with the requirements of M.G.L. a 53.
Sign ! / 1 on
SCHEDULE A: RECEIPTS
X1.G.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts
0vt!r $50. in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
iti'nlize those receipts over $30. In addition, the occupalrvn and employer must be reported for all persons who
e(yaribute $200 or more in a calendar year.
1 page may be copied if additional pages are required to report all receipts. Please include your committee name and a page
a.P nn Paeh nacre
Date
Received
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
y. -,
Line 9: Total receipts in excess of $50 (or listed above)
) 6
Enter on page 1, line 2
I.'-- n r : e to �t-0A innhlAP nnly thncr± rt•rEintS not itemb
Line 10: Total receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD
_.__A_ .z-_— :_
,ed
i if you have itemized receipts of aou and under inctuue weltt tit ,.,t` call. ... � ................... ..... _____
above.
Page 2
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.
This page may be copied if additional pages are required to report all expenditures. Please include your committee name and a page
number on each naee.
- Date Paid Paid
To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
�/
l 1 CJ l?rleass , 'Roe
1 4
Enter on page 1, line 4
Line 12: Expenditures over $50
3
��
Line 13: Expenditures $50 and under*
56
Line 14: TOTAL EXPENDITURES
\L\
6
*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 -KM" 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 recor and included in line 16.
Date From Whom Received* Residential Address Description of Value
Received Contribution
3�ltk l-® \� 5� sk�% ea. se�_�
Line 15: In -kind over $50
Line 16: In -kind $50 and under
Enter on page 1, line 6
Line 17: Total In - kind
* 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
To Whom Due
Address
Purpose
Amount
Incurred
c;
, (-n
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. " printed on recycled paper Page 4
61 L °3 C'
Form CPF M 102 -0: Campaign Finance Report
Municipal Form LE � i A
Office or campaign and Political Finance
Cewwonwedth '
otMtwechuune '
City or Town of: Candidate Office
Please print or type all information, except signatures.
Fill in dates: Month Day Year Month Day Year
Reporting Period Beginning Ending
Type of Report: (Check One)
8th day preceding 8th day preceding election 30th day following election 20th day of January
preliminary/primary (Town or Special) (Year -End Report)'
Pursuant to M.G.L., Chapter 55:
1. I certify that I am a candidate for or hold Municipal Office.
2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this
reporting period, and do not have a campaign fund in existence.
3. I certify that I do not have a political committee.
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