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Form CPF M 102 -0: Campaign Finance Report
Municipal Form
bmee of Campaign and Pomleal Finance
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CityorTownof: Candidate
Please print or type all Information, except signatures,
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Fill in dates:
Reporting Period Beginning__
Month
Day Year
Month
Day
Year
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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. 1 certify that I am a candidate for or hold Municipal Office.
2. 1 certify that t 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. 1 certify that I do not have a political committee.
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