HomeMy WebLinkAbout2016-12-31-Brodner-OCPFCommonwealth
of Massachusetts
Form CPF M 102: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
File with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: Beginning Date:
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Ending
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Type of Report: (Check one)
❑ 8th day preceding preliminary El 8th day preceding election ❑ 30 day after election year -end report ❑ dissolution
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Candidate Full Name (if applicable)
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Office Sought and District
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Residential Address
Telephone Number (optional):
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Committee Name
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Name of Committee Treasurer
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Committee Mailing Address
Telephone Number (optional):
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)
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:
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: pit at 16 ' £SesL (Treasurer's signature)
Date:
FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only)
Candidate with Committee and no activity independent of the committee
yiI 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 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 OR 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.
Signed under the penalties of perjury: ,/"d9 " — ./°� (Candidate's signature) Date:
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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. Expenditures $50 and under may be added together,
from committee records, and reported on line 13.
(A "Schedule B 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
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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)
Line 14: TOTAL EXPENDITURES IN THE PERIOD
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* 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 4