HomeMy WebLinkAbout2015-12-31-Kelley-OCPFCommonwealth
of Massachusetts
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Municipal Form
Office of Campaign and Political Finance
File with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: Beginning Date:
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Type of Report: (Check one)
LI 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election Y't year -end report ❑ dissolution
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Candidate Full Name (if applic ble)
Office Sought and District
Telephone Number (optional):
Residential Address
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Committee Manic
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Name of Committee Treasurer
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Commi 'e Mailing Address
Telephone Number (optional):
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SUMMARY BALANCE INFORMATION:
Line 1: Ending Balance from previous report
Line 2: Total receipts this period (page 3, line 11)
Line 3: Subtotal (line I 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 fmance
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�--� j
this committee in accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury: L Cq \ • w e t& QLC.l,W -.Q (Treasurer's signature)
Date:
FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check I box only)
Candidate with Committee and no activity independent of the committee
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, 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 true 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
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Gndidatn's sipnannef
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Date Received
Name and Residential Address
(alphabetical listing required)
1
1
1
Amount
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Occupation & Employer
(for contributions of $200 or more)
1
i
1
1
1
Line 9: Total Receipts over $50 (or listed above)
Line 10: Total Receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD
1
* if you have itemized receipts of $50 and under, include them in line 9. Line 10 d include only those receipts not itemized above.
F Enter on page 1, line 2
M.G.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 in a reporting period. Committees must keep
detailed accounts and records of all expenditures, but need only itemize those over $50. Expenditures $50 and under may be added together,
from committee records, and reported on line 13.
(A "Schedule B: Expenditures" attachment is available to complete, print and attach to this report, if additional pages are required to
report all expenditures. Please include your committee name and a page number on each page.)
To Whom Paid
(alphabetical listing)
Date Paid
Address
Purpose of Expenditure
Amount
1
1
Line 12: Total Expenditures over $50 (or listed above)
Line 13: Total Expenditures $50 and under* (not listed above)
Line 14: TOTAL EXPENDITURES IN HE PERIOD
Enter on page 1, line 4 - I
* If you have itemized expenditures of $50 and under, include then in line 12. Line 13 should include only those expenditures not itemized
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 I.
Date Received
From Whom Received*
Residential Address
Description of Contribution
1
Value
1
i
Line 15: In -Kind Contributions over $50 (or listed above)
Line 16: In -Kind Contributions $50 & under (not listed above)
Line 17: TOTAL IN-HIND CONTRIBUTIONS
Enter on page 1, line 6 -
a 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 thpp rnntrihutnr in addition if the contribution k seen nr more von cornet aka rennrt the enntrihutnr'c nrennatinn and emnlnver
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
r
Line 18: TOTAL OUTSTANDING LIABILITIES (ALL) I
0 1
Enter on page 1, line 7 -,