HomeMy WebLinkAbout2016-12-31-Pato-OCPFForm CPF M 102: Campaign Finance Report /III -I
Municipal Form,
Office of Campaign and Political Flume
Pile with;
City or Town Clerk or Elation Coumdalon
Please print or type all information, except signatures.
Fill in dates: syra5
Reporting Period Beginning A I ,
20Yr6 Ending vecemberpa 31 21716
Type of report: (Check one)
08th day preceding preliminary 081h day preceding election °30 day alter election ®year-end report °dissolution
,Joe Pato
Full Name of Candidate (If applicable)
Selectman
Office Sought and Dhlrict
900 Mass. Ave., Lexington, MA 02420
. Residential Address
Tel. No. (optional)
Committee to Elect Joe Pato Selectman
Committee Name
Kerry Brandin
Name of Committee Treasurer
16 Franklin Rd, Lexington, MA 02420 •
Committee Mailing Address
Tel. No. (optional)
SUMMARY BALANCE INFORMATION:
Line 1: Ending balance from previous report $ 200.00
Line 2: Total receipts this period (page 2, line 11) $ 0.00
Line 3: Subtotal pine 1 plus tins 2) $ 200.00
Line 4: Total expenditures this period (page 3, line 14) $ 0.00
Line 5: Ending balance (line 3 mints lino a) $ 209.17
Line 6: Total in -kind contributions this period (page 4) $ 14.99
Line 7: Total (all) outstanding liabilities (page 4) $ a 17
Line 8: Name of bank(s) used Cambridge Savings Bank
Affidavit of Committee Te asurea
I artily that I have exandned Ode report including attached schedules and it is, to the bat of my knowledge and belief, a true end complete sWemem of all ampatgt
finance activity, including all comnbudan, loon, receipts, axpeediturea, di.Wnaneree, unkind contributions and Iubllilla for this reporting period and represents the
campaign finance activity of all perdu actingunda the authority or bdsifof lNa committee in accordance with the requ'remcnu of M.QL a. SS.
Signed under the penalties of perjury'
Treasurer's aiputua* On ink)
Date
FOR CANAMIj4TE FILINGS ONLY: (CANDIDATE MUST SIGN BELOW)
Affidavit orCandidater (check 1 box only)
0 Candidate with Comnilltee and no tedMty independent orthe manatee*
I certify that I We examined this repot including steadied schedules and it is, to the bat any knowledge and belief, a true and complete statement oral! campaign
rinence activity, ofal pan acting mks. the authorttyor on bdulfof Uric carmine, in accordancewith the requirements of M.O.L o. SS. I have not received any
ooarituUom, Intoned any liabilities nor nude any expo dllwa onmy behalf during Ude reporting period
O Ca didatewithout Commnke O�Candidate with Independent activity filing separate report
I witty out i have examined this report Including alnutad schedules and it k to the bat of my knowledge and belle4 a we and complete statement of all an ,sign
fiance activity, including contributions, loam, receipts, expndibuµ disbursements, btkind conuibuQom and liabilities for thin reponing period and represents the
campaign finance activity of all pesau acting under the authority or on Walter Ihu ootmniice in accordance with the aqubemenu of M.O.L a SS,
Signed under the penalties of perjury; r
if
Data
SCHEDULE A: RECEIPTS
H/,C.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts
over $50.in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
itemize those receipts over $50. In addition, the occupation and employer must be reported for all persons who
e11tribute $200 or more in a calendar year.
this page may be copied if additional pages are required to report all receipts. Please include your committee name and a page
Date
Received
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
Line 9: Total receipts in excess of $50 (or listed above)
00
00
— Line 10: Total receipts $50 and under' (not listed above)
m
00
line 11: TOTAL RECEIPTS IN THE PERIOD
00
00
Enter on page 1, fine 2
+ if you have Itemized receipts of $50 and under Include them In lino 9. Line 10 should include only those eeceipts not itemized
above.
SCHEDULE B: EXPENDITURES
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.
Lkpenditures $50 and under may be added together, from committee records, and reported on line 13,
This page may be copied if additional pages are required to report all expenditures. Please Include your committee name and a page
Date Paid
^ To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
Enter on page 1, line 4
Line 12: Expenditures over $50
DO
00
Line 13: Expenditures $50 and under*
00
®
Line 14:TOTAL EXPENDITURES
m
co
*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 3
SCHEDULE C: "IN -KIND" CONTRIBUTIONS
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.
Date
Received
From Whom Received*
Residential Address
Description of
Contribution
Value
9/14/2015
John Krawezk
78 Outlook Drive
Lexington, MA 02421
.com Domain - lost check #6
uncashed; reissued 1/3/17
yg 17
Enter on page 1, line 6
Line 15: In -kind over $50
003
Line 16: In -kind $50 and under
14.99
Line 17: Total In -kind
14.99
• 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 the contributor; in addition, if the contribution is $200 or more, you must also report the contributors occupation and
employer.
SCHEDULE D: LIABIL1IThS
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
9/14/2015
John Krawezk
78 Outlook Drive
Lexington, MA 02421
.com Domain - lost check #6
uncashed; reissued 1/3/17
yg 17
Enter on page 1, line 7
Line 18: OUTSTANDING LIABILITIES (ALL)
$9.17
This page may be copied if additional pages are required to report all activity. Please include your committee name and a page
number on each page. ��, polled on recycled caner Page 4