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Form CPF M 102-0: Campaign Finance Report
Municipal Form
bflicc of Campaign and Political Flnancc
City or Town of:
telly
Candidate k2//14 L J 727k'/7 Office
Please print or type all Information, except signatures,
Fill in dates: Month Day Year Month Day Year
B
Reporting Period Beginning / 7U / Lf Ending )'J/ 77% 1/0 /L`
Type of Report: (Check One)
8th day preceding ° 8th day preceding election 0 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. 1 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 I do not have a political committee.
DATE
I. SIGNATURE
Signed under the penalties of perjury
11. RESIDENTIAL ADDRESS
(Street and Number)
III. OFFICE SOUGHT
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