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Form CPF M 102 -0: Campaign Finance Report
Municipal Form
office otCampaign and Political Finance
City or Town of:
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Candidate Net` ti• (/ mi l Office I— MA
Please print or type all Information, except signatures.
Fill in dates: Month Day Year Month Day Year
Reporting Period Beginning (
i 2 91 Ending ) z_ 3 I 235 11
Type of Report: (Check One) {,
o 8th day preceding 0 8th day preceding election 0 30th day following election Sd' 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 1 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 1 do not have a political committee.
DATE
I. SIGNATURE
Signed under the penalties of perjury
I1. RESIDENTIAL ADDRESS
(Street and Number)
(1I. OFFICE SOUGHT
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m itee.s SC
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11197
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