HomeMy WebLinkAbout2024-01-12-Jensen-OCPF f
Form CP M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
MUNICIPALsFORT
Commonwealth Office of Campaign and Political Finance
of Massachusetts
Filewith- City/Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55, as amended, of thee, r ani i n of a
candidate's committee a follows: 4 1-,...
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CANDIDATE: Full Name: � Je e,ki � ' �...-
Residential Address-
Ree
City 1State dip. Le)c k . .
E-Mail Address. � 1 � � � ��. t � � ",1PhoneNJ
c
Party Affiliation: w If applicable)
OFFICE SOUGHT/PURPOSE:
Title: 0 _
District:
NMTT , Naive ofCommittee: � � `� � �
(The name of the eommitt must include the candidate's last naive)
Committee Mailing Address:
City State!Zip: LQ ` ; `'�1 VAo-1-42-1 Phone#:
OFFICERS:
Chairman: 'Treasurer*: U
Residential Address: Residential Address: { C4
City/State/Zip: city/State f Zip: r �-
w
Phone#; Phone##: Y60l�
�� inail: � . �� 446� UM -
*A i2ubIic em r I ov e ina not serve as treasurer of gMp oIitical committee see reverss.
Other Officer/T'it]e: Other Offt cer/Tit]e:
Residential Address: Residential Address:
City/State I Zip: City 1 State I Zip:
Phone : Phone :
omplete and attach a Donn CPF M A 101,if necessary,with other officers and finance committee,if any.)
I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her -
behalf,. I am aware that candidates aro required to keep detailed accounts and records of all campaign finance activity for a period of six years from the elate of
the relevant election. -
SIND UNDER THE PENALTIES OF PERJURY:
Date: l' .
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.01,1,c.55,s. 13.I understand
that: 1 I am subject to certain duties and liabilities under M. .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 fi•orn the date of the relevant election; if atter my acceptance of this office I become ars
appointed public employee,I must resign this position and notify OCP 'of my resignation;and a candidate may not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED SER THE PENALTIES OF PERJURY: ,}� Date: Y
,r
Treasurer's signature
I hereby accept the office of Chairman of the above--named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
Date:
Chairman's signature