HomeMy WebLinkAbout2023-12-19-Arens-OCPF Form CPF M101: STATEMENT.OF ORGANIZATION
CANDIDATE OR CANDIDATE'S COMMITTEE
MUNICIPAL FORM
`F
Commonwealth Office of Campaign�and Political Fu>rcc
ofNlassachusetts
file with: City/Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Lfu
tiamended,organization of a candidate or
candidate's committee as follows:
CANDIDATE: Full Name: Cynthia Arens
Residential Address: 7 Kitson Park Dr.
City/State/Zip: Lexington MA 02421
E-Mail Address: cindy4lex@gmail.com Phone#: 781-354-3806-
Party
81-354-3806-Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Title: Select Board District:
Candidate without committee(check if applicable).If checked,do not complete committee or officer sections:sign as candidate,
0 date and file with clerk or local election official.
COMMITTEE: Name of Committee: Committee to Elect Cindy Arens
(The name of the committee must include the candidate's last name)
Committee Mailing Address: 7 Kitson Park Dr.
City I State/Zip: Lexington MA 02421 Phone#: 781-354-3806
OFFICERS:
Chairperson: Diane Pursley Treasurer*: Jeanne Krieger
Residential Address: 21 Turning Mill Rd. Residential Address: 44 Webster Rd..
City I state/Zip: Lexington MA 02420 City 1 State/Zip: Lexington MA . 02421
Phone#: 781-266-7679 Phone#: 781-718-5742 Email: kr1egerjk440gmai1.com
*A public em to ee may not serve as treasurer of any political committee see reverse).
Additional officers may be listed on page two.
Check applicable box before signing:
N Candidate with committee:I hereby 1)consent to this filing',2)understand that a candidate.shall not consent to the organization of more than one account
or committee on their behalf;3)am subject to certain duties and liabilities under M.G,L.c.55,including the timely filing of campaign finance reports and
keeping detailed accounts and records of all campaign finance activity for a period of six years from the date of the relevant election;and 4)may not serve as
treasurer of a political committee organized on my behalf.
0 Candidate without committee:I hereby 1)consent to this filing;2)understand that a candidate shall not consent to the organization of more than one
account or committee on their behalf;3)acknowledge if I become a public employee I must organize a committee and may not serve as treasurer;and 4)am
subject to certain duties and liabilities under M.G.L.c.55 including the timely filing of campaign finance reports and keeping detailed accounts and records of
all campaign finance activity for a period of six years from the date of the relevant election.
Date: ) )5 U O
SIGNED UNDER THE PENALTIES OF PERJURY: — D— --
Candidate's signature
I hereby accept the office of Treasurer of the above-named committee.I affirm that I am not a public employee as defined by M.G.L.c.55,s. 13.1 understand
that: 1)I am subject to certain duties and liabilities under M.G.L.c.55, including the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of six years from the date of the relevant election;2)if after my acceptance of this office I become an
appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political
committee organized on their behalf.
SIGNED UNDER THE PENALTIES OF PERJURY: Date:
Treasurer's signature
I hereby accept the office of Chairperson of the above-gamed committee.
SIGNED UNDER THE PENALTIES OF PERJURY: Date:
Chairperson's signature