HomeMy WebLinkAbout2015-02-23-Kelley-OCPFCommonwealth
of Massachusetts
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Municipal Form
Office of Campaign and Political Finance
File with: Cih• or Town Clerk or Election Commission
Fill in Reporting Period dates: Beginning Date: 11/45txn, I tot 5
Ending Date:
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Type of Report: (Check one)
❑ 8th day preceding preliminary 8th day preceding election ❑ 30 day after election 9 year -end report 9 dissolution
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Candidate Full (if applicable)
Name of Committee Treasurer
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Committeailing Address
Office and District
Telephone Number (optional): 1 O.1 — Ro 1 — aggi&
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Residential Address
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Telephone Number (optional): �E' -I _ 1tt1.(0
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Committee Name
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Name of Committee Treasurer
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Committeailing Address
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Telephone Number (optional): 1 O.1 — Ro 1 — aggi&
SUMMARY BALANCE INFORMATION:
Line 1: Ending Balance from previous report
Line 2: Total receipts this period (page 3, Tine 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)
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Line 6: Total in -kind contributions this period (page 6)
Line 7: Total (all) outstanding liabilities (page 7)
Line 8: Name of bank(s) used:
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Affidavit of Committee Treasurer:
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 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 on behalf of this committeejn accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury: $ CL 1 (Treasurer's signature) Date: a--
FOR CANDIDATE FILINGS ONLY: Affidavit of Cnndidate: (elieck 1 box only)
andidate with Committee and no activity independent of the committee
I certify that 1 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. 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 tune 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 under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55.
Date: 1 z_ cO _ 20 I.5
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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 records and included in line 16 on page 1.
Date Received
From Whom Received*
Residential Address
Description of Contribution
Value
Enter on page 1, line 6 —>
Line 15: In -Kind Contributions over $50 (or listed above)
Line 16: In -Kind Contributions $50 & under (not listed above)
Line 17: TOTAL IN -KIND CONTRIBUTIONS
* 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. Ro 6
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 Incurred
To Whom Due
Address
Purpose
Amount
Enter on page I, line 7 -
Line 18: TOTAL OUTSTANDING LIABILITIES (ALL)
0
Penn '1
M.G.L. c. 55 requires that the name and residential address be reported in alphabetical order, for all receipts over $50 in a calendar
year. Committees must keep detailed accounts and records of all receipts, but need only itemize those receipts over $50. In addition, the
occupation and employer must be reported for all persons who con0•ibute $200 or more in a calendar year.
(A "Schedule A: Receipts" attachment is available to complete, print and attach to this report, if additional pages are required to
report all receipts. Please include your committee name and a page number on each page.)
Date Received
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
Line 9: Total Receipts over $50 (or listed above)
Line 10: Total Receipts $50 and under* (not listed above)
F Enter on page I, line 2
Line 11: TOTAL RECEIPTS IN THE PERIOD
Q
* If you have itemized receipts of $50 and under, include then in line 9. Line 10 should include only those receipts not itemized above.
1
SCHEDULE 11: EXYPdND11 Ul(LS (conilnuet)
Date Paid
To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
Enter on page 1, line 4 -
Line 12: Expenditures over $50 (or listed above)
Line 13: Expenditures $50 and under* (not listed above)
Line 14: TOTAL EXPENDITURES IN THE PERIOD
0
* If you have itemized expenditures of $50 and uncle', include them in line 12. Line 13 should include only those expenditures not itemized
above.