HomeMy WebLinkAbout2016-02-22-Anderen-OCPFCommonwealth
of Massachusetts
Form CPF M 102: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
File with_rA.lity be o,F clerk �Fie tioii Ci'ontmission
Fill in Reporting Period dates: Beginning Date:
'Jan 1, 2016
Ending Date: Feb 22, 2016
Type of Report: (Check one)
8th day preceding preliminary
8th clay preceding election ❑ 30 day after election ❑ year -end report ❑ dissolution
'Mark Andersen
Campaign to Elect Mark Andersen
Candidate hill Name (if applicable)
Committee Name
School Committee member
'Daniel P. Blake
Name of Committee Treasurer
Ounce Sought and District
12 Thoreau Rd, Lexington, MA 02420
12 Thoreau Rd, Lexington, MA 02420
Committee Mailing Address
Residential Address
Telephone Number (optional):
Telephone Number (optional):
SUMMARY BALANCE INFORMATION:
Line l: Ending Balance from previous report
Line 2: Total receipts this period (page 3, line 11)
Line 3: Subtotal (line I plus Zinc 2)
Line 4: Total expenditures this period (page 5, line 14)
Line 5: Ending Balance (line 3 minus line 4)
0
100
100
100
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:
0
0
0
Citizens Bank
Affidavit of Committee Treasurer:
I certify that I have examined this report including attac tF1el,edules 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, ex( enditure.. disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign
linancc activity of all persons acting under the authority o nr to f if lm}it 1e in accordance with the requirements of M.QI,. c. 55. q
(Treasurer's signature) Date: � , / /[7
Signed under the penalties of perj mv:
FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only)
Candidate 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 linancc
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 00 my behalf during this reporting period.
Candidate willmut Committee DR 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 any knowledge and belief, a true and complete statement of all campaign
❑ linancc activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period •cod represents the
campaign linancc activity of all persons acing under/he authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55.
under/ he
Signed under the penalties of perjury: (Candidate's signature)
SCHEDULE A: RECEIPTS
A/.G.L. c. 55 requires that the name and residential address he reported, in alphabetical order, for all receipts over S50 in a calendar
year. Committees must keep detailed accounts and records of a// receipts, but need only itemize those receipts over 850. In addition, the
occupation and employer must be reporter/ for all persons who contribute 8200 or more in a calendar pear.
(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
0,ccu tati49 St Eniployer_t
(for emitl'ihntions'of $201lor store)
E- Enter on page I, line 2
Line 9: Total Receil is over $50 (or listed above)
Line 10: Total Receipts $50 and under* (not listed above)
100
Line 11: TOTAL RECEIPTS IN THE PERIOD
100
* If you have itemized receipts of $50 and under, include them in line 9. Line 10 shoul I include only those receipts not itemized above.
Page 2
SCHEDULE B: EXPENDITURES
KG. L. c. 55 requires committees to list, in alphabetical order, all expenditures over 350 in a reporting period. Committees HMS( keep
detailed accounts and records of all expenditures, but need only itemize those over 550. Expenditures 350 and under may he added together,
front committee records, and reported on line 13.
(A "Schedule ti: 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.)
Date Paid
To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
Feb 7, 2016
Chinese American Association of
Lexington
Advertisement
100
Enter on page I, line 4 -->
Line 12: Total Expenditures over $50 (or listed above)
100
Line 13: Total Expenditures $50 and under* (not listed above)
Line 14: TOTAL EXPENDITURES IN THE PERIOD
100
* 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 4