HomeMy WebLinkAbout2016-12-31-Andersen-OCPFCommonwealth
of Massachusetts
Form CPF M 102: Campaign Finance Report
Municipal Forni
Office of Campaign and Political Finance
j,l °l O i. >.
File Ci e all: }'�or 1'ow "n CidR o I(?,ilecu n Con
551011
Fill in Reporting Period dates: Beginning Date:
Jan 1, 2016
Ending Date: D.ec 31, 2016
Type of Report: (Check one)
8th day preceding preliminary 0 8th day preceding election ❑ 30 day after election Ej year -end report ❑ dissolution
[Mark Andersen
Candidate Full Name (if applicable)
School Committee member
Office Sought and District
2 Thoreau Rd, Lexington, MA 02420
Telephone Number (optional):
Residential Address
Campaign to Elect Mark Andersen
Committee Name
'Daniel P. Blake
Name of Connuittee'freasurer
2 Thoreau Rd, Lexington, MA 02420
Committee Mailing Address
Telephone Number (optional):
Line I:
Line 2:
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)
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: 'citizens Bank
SUMMARY BALANCE INFORMATION:
Ending Balance from previous report
Total receipts this period (page 3, line 11)
0
100
100
100
0
0
0
. \Mari( of Committer Treasurer:
I certify that 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, inch ding all contributions, loans, receipts, expenditures, disbursemey s, in- td contributions and liabilities for this relenting period and represents the campaign
finance activity of all persons acting under the aulho, rik inrin lelwl IhigJcyfim e in accordance with the requirements of NULL. c. 55.
Signed under the penalties of perjury:
(Treasurer's signature)
Date:
/7/
FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check I box only)
Candidate with Committee and no activity independent of the committee
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. of all persons acting under the authority or on behalf of this committee in accordance with the requirements of c. 55. 1 have not received any contributions,
incurred any liabilities nor made any expenditures on my behalf during this reporting period.
Candidate without Committee OR Candidate with independent activity filing separate report
I cedily that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a hue 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 persona aging under the aidhority or on behalf of1his committee in accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury:
(Candidate's signature) Date:
SCHEDULE A: RECEIPTS
dLG.L. c. 55 requires that the name and residential address be reporter!, in alphabetical order, for all receipts over $50 in ra calendar
year Committees must keep detailed accounts and records ofall receipts, but need only itemize those receipts over S50. In addition, the
occupation and employer durst be reported for all persons who contribute 5200 or more in a calendar ['ear.
(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
Occupation & Employer
(for contributions of $200 or more)
Line 9: Total Rece ipts over $50 (or listed above)
<- Enter on page I, line 2
Line 10: Total Receipts $50 and under* (not listed above)
100
Line 11: TOTAL RECEIPTS IN THE PERIOD
100
* Ifyou have itemized receipts of$50 and under, include then in line 9. Line 10 should include only those receipts not itemized above.
Page 2
SCHEDULE B: EXPENDITURES
Al G. L. c. 55 requires committees lo list, in alphabetical order, all expenditures over 550 in a reporting period Committees mast keep
detailed accounts and records o/ all expenditures, but need only itemize those over 550. Expenditures 550 and uncler nap' he added together,
,from committee records, and reported on line 13,
(A "Schedule E: 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
r
1
r
rMi
Enter on page I, line 4 ->
Line 12: Total Expenditures over $50 (or listed above)
loo
Line 13: Total Expenditures $50 and under* (not listed above)
Line 14: TOTAL EXPENDITURES IN THE PERIOD
100
* Ifyou have itemized expenditures of $50 and under include them in line 12. Line 13 should include only those expenditures not itemized
above.
Page 4