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Form CPF M 102-0: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
City or Town of:
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Candidate}�C5 a �r5 A- Mesva Lr,utioffice Cv.«t,t.rt 112e
Please print or type all Information, except signatures.
Fill in dates: Month Day Year Month Day Year
Reporting Period Beginning .1 fw a w ) Le I) Ending P .ec. 3 1 a
Type of Report: (Check One)
o 8th day preceding 0 8th day preceding election 0 30th day following election 0 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.
DATE
1. SIGNATURE
Signed under the penalties of perjury
IL RESIDENTIAL ADDRESS
(Street and Number)
11I. OFFICE SOUGHT
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