HomeMy WebLinkAbout2015-12-31-YesforLexington-OCPFCommonwealth
of Massachusetts
Form CPF M 102: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
Fill in Reporting Period dates: Beginning Date:
File with: City or Town Clerk or Election Commission
Ending Date:
1 EL 15
Type of Report: (Check one)
❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election [✓year-end report ❑ dissolution
Candidate Full Name (if applicable)
Office Sought and District
Telephone Number (optional):
Residential Address
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Committee Name
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Name of Committee Treasurer
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Committee Mailing Address
Telephone Number (optional):
SUMMARY BALANCE INFORMATION:
Line 1• Ending Balance from previous report
Line 2: Total receipts this period (page 3, line 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 Connnittee 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 t e uthryity or on behalf of this committee in accordance with the requirements of M.O.L. c. 55.
Signed under the penalties ofperjury: (Treasurers signature) Date:
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FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 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 Oft 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.
Signed under the penalties of perjury: (Candidate's signature) Date:
SCHEDULE A: RECEIPTS (continued)
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)
e- Enter on page 1, line 2
Line 10: Total Receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD
* If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.
Page 3
SCHEDULE B: EXPENDITURES (continued)
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
* If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemized
above.
Page 5
SCHEDULE D: LIABILITIES
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 Ltcurred
To Whom Due
Address
Purpose
Amount
Enter on page 1, line 7 -*
Line 18: TOTAL OUTSTANDING LIABILITIES (ALL)
Page 7