HomeMy WebLinkAbout2017-12-31-Kelley-Dissolution?'p�cs ((, 20 t rl
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Municipal Form_ -
Office of Campaign and Political Finance b
Commonwealth I '
of Massachusetts L EX i 3
File with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: Beginning Date: �p` ( 1 7 Ending Date: I I . -3k uj
Type of Report: (Check one)
❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year-end report Vdissolution
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Candidate Full Name (i pplicable)
Office Sought and District
R ST S e-�
Residential A dress
Telephone Number (optional): I ')sI
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Committee Name
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Name of Committee Treasurer
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Comn6ee Mailing Achiress
Telephone Number (optional): I Jol—g(p(, gq g
SUMMARY BALANCE
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) 0
Line 7: Total (all) outstanding liabilities (page 7) Q
Line S: Name of bank(s) used:
dfidavit of Committee Treasurer:
certify drat I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a [rue and complete statement of all campaign finance
etivity, 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.
igned under the penalties of perjury: l Q-. Kl(A. � , - W k -n it Q 1l 4 (Treasurer's signature) Date:
Affidavit of Candidate: (check 1 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 M.G.L. c. 55. t 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 ceri& 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
fmmce activity, including contributio , ans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the
.=paign finance activity of all perso a C g der t uthority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. Ou!•-
M G.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 contribute $200 or more in a calendar year.
(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)
V
Line 9: Total Receipts over $50 (or listed above)
F Enter on page 1, line 2
Line 10: Total Receipts $50 and under* (not listed above)
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.
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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.
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.
of the r.nntrihotor• in nr9Aition if the rnnfrihotinn is G900 or more no mnet algin report the. rnntrihomr's nnnnnntinn and emnlnver