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HomeMy WebLinkAbout2016-12-31-Kelley-OCPFCommonwealth of Massachusetts Municipal Form Office -a ampaign and Political Finance 1111.1 -6 Ail ICI: ti'3 File with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Bee(ni itiiArptjtgj;i` Ending Date: I `j-" ?7 \ ZO l6 Type of Report: (Check one) �/ El 8th day preceding preliminary ❑ 8th day preceding election El 30 day after election year -end report ❑ dissolution RthP e- - 3. -Ke \1e y Candidate Full Nwne (if applicable) le r*tnoc'\ Office Sought and District �c+ �r�,, 9 C�rZeS-V & • 1.-24. \ I G._ X4-2 -1 l Residential Addres Telephone Number (optional): '781- 51(o \ - k5 'AL Con ittee Mailing Address • iL at 1 • - - - .- .•1 -so wn Committee Name jINDiA ^3. 03(tl,a Name of Committee Treasurer 1 /o RfL55e 11 . neohm, (x(l0,0aME70 Telephone Number Con ittee Mailing Address (optional): 1 7sI - salp 1 - air tig 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) A 1096, r7 of 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: I o1(o. rl`+ 0 0 r1(o • 1 of 0 Affidavit of Committee 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 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: • �uL)l.�L- 7--),I L_2 (Treasurer's signature) Date: 1 -1- 90 11 FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) /Candidate with Committee and no activity independent of the committee Syr . certify that I have examined this report including attached schedules and it is, to are best of my knowledge and belief, a true and complete statement of all campaign finance 1J 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 QR 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. 11- I-20lq 1 Date Received Name and Residential Address (alphabetical listing required) Amount Occupation & Employer (for contributions of $200 or more) r . , , 62. C) .1-- cn Enter on page 1, line 2 Line 9: Total Receipts over $50 (or listed above) 0 Line 10: Total Receipts $50 and under* (not listed above) 0 Line 11: TOTAL RECEIPTS IN THE PERIOD 0 * If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above. 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. Expenditures $50 and under may be added together, from committee records, and reported on line 13. (A "Schedule 13 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 (- >rc v Enter on page 1, line 4 -* Line 12: Total Expenditures over $50 (or listed above) Line 13: Total Expenditures $50 and under* (not listed above) C Line 14: TOTAL EXPENDITURES IN THE PERIOD 0 * If you have itemized expenditures of $50 and under include them in line 12. Line 13 should include only those expenditures not itemized 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 on page 1. Date Received From Whom Received* Residential Address Description of Contribution Value , i t. Enter on page t, line 6 -- Line 15: In -Kind Contributions over $50 (or listed above) O Line 16: In -Kind Contributions $50 & under (not listed above) a Line 17: TOTAL IN-KIND CONTRIBUTIONS a * 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 enntrihntnr• in additinn if the rnntrihntinn is (900 nr tnnre vnn mast nlcn rennrt the rnntrihNm'c nrennation and emnlnver 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 Enter on page 1, line 7 -> Line 18: TOTAL OUTSTANDING LIABILITIES (ALL) 0