HomeMy WebLinkAbout2017-12-31-Comm for Masterplanning before Bldg-DissolutionForm CPF M 102: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
Commonwealth
of Massachusetts
File ry ttr City or Town Clerk or Election Commission
r r�
Fill In Reporting Beginning Date: I —a7 -7_0)I Ending Date: —,2,0I%
Type of Report: (Check one)
❑ 8th day preceding preliminary ❑ 8th day preceding election 0 day atter election ❑ year-end report tssolution
Candidate Full Name (if applicable)
Office Sought and District
Residential Address
Telephone Number (optional):
BALANCE
Committee Name
miN 7 a
Name of Committee Treasurer
ihbrea�. S fit .<
Committee Mailing Address
Telephone Number (optional):
Line 1: Ending Balance from previous report
Line 2: Total receipts this period (page 3, line 11)
Line 3: Subtotal (line I plus line 2)
Line 4: Total expenditures this period (page 5, line 14)
Line 5: Ending Balance (line 3 minus line 4)
TION:
W
Line 6: Total in-kind contributions this period (page 6) ( 3 0 5
Line 7: Total (all) outstanding liabilities (page 7) �—
Line 8: Name of bank(s) used:
certify 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
ictivity, including all contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign
!nonce activity of all persons acting under the fo
autho or on behaI foftt'h'is committee in accordance with the requirements of M.G.L. c. 55. 7
signed under the penalties of perjury: // 6-1J� (Treasurers signature) Date:
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 ander 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,
incurted any liabilities nor made any expenditures on my behalf during this reporting period.
Candidate without Committee OR Candidate with independent activity filing separate report
E]1 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 al I 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.
under the penalties of perjury:
signature) Date:
SCHEDULE A: RECEIPTS
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 most keep detailed accounts and records ofall receipts, but need only ilemize those receipts over $50. In addition, the
occupation and employer must be reported far 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)
FD
,
0
C
Line 9: Total Receipts
over $50 (or listed above)
listed
Line 10: Total Receipts
$50 and under* (not above)
K--- Enter on page 1, line 2
Line 11: TOTAL
RECEIPTS IN THE PERIOD
* If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.
Page 2
SCHEDULE A: RECEIPTS (continued)
Date Received
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
Line 9: Total Receipts over $50 (or listed above) L
Total Receipts $50 (not listed above)
Line 10: and under*
E Enteron page 1, line 2
Line 11: TOTAL RECEIPTS IN THE PERIOD
* If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.
Page 3
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,
front 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
.,rr �n ar.,>nditnrec_ Please include vnnr committee name and a page number on each page.)
Date Paid
To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
F7=
F
F
F
F
-F-F-
F7=F
7F=F=
-1
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
Enter on page 1, line 4 -
* If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditm•es not itemized
above. Page 4
SCHEDULE B: EXPENDITURES (continued)
Date Paid
To Whom Paid
(alphabetical listing)
E-
Address
IF
Purpose of Expenditure
--:7:1
Amount
L
F-
F-
F-
- ::=
F-
F
F --=F7=
I F -
Line 12: Expenditures over $50 (or listed above)
Line 13: Expenditures $50 and under* (not listed above)
IN THE PERIOD
Enter on page 1, line 4 -
Line 14: TOTAL EXPENDITURES
* 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 5
SCHEDULE C: "IN -HIND" 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 on page 1.
Date Received I From Whom Received*
-as?Ck�I MC.rk An�e/5
Residential Address
S'-1-
Value
61458
.-- � 4iI Wt�tr7 G'� � Zi
1 atter z i
15: In -Kind Contributions over $50 (or listed above) 173-53
Line 16: in -Kind Contributions $50 & under (not listed above)
Enter on page 1, line 6 � I Line 17: TOTAL IN -HIND CONTRIBUTIONS 173-53
* 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 contributor's occupation and employer. page 6
SCHEDULED: LIABILITIES
M.G. L. a 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
F7:7
F-
F7
1: :1,
F -F-
=1
F-
F-=
F ---
F
F
F
F-=
F-=
=,
F7=1
F-
F-=
F-=
F-=
=--]
F I
Enter on page 1, line 7 -
Line 18: TOTAL OUTSTANDING LIABILITIES (ALL)
Page 7