HomeMy WebLinkAbout2017-12-31-Andersen-DissolutionForm CPF M 102: Campaign Finance Report
Municipal Form
'Trice of Campaign and Political Finance
Commonwealth t:fty 77
of Massachusetts lul ? t 7 tw?• 3a,
File with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: i ' Beginning Date: v )an 1, 2017 Ending Date: Dec 31, 2017
LEfI,'t
Type of Report: (Check one)
❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after electionX❑ year-end report X❑ dissolution
Andersen
Candidate Full Name (if applicable)
Office Sought and District
2 Thoreau Rd, Lexington, MA 02420
Residential Address
Campaign to Elect Mark Andersen
P. Blake
Committee Name
None of Committee Treasurer
12 Thoreau Rd, Lexington, MA 02420
Committee Mailing Address
SUMMARY BALANCE INFORMATION:
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)
0
0
0
0
Line 6: Total in-kind contributions this period (page 6) I 01
Line 7: Total (all) outstanding liabilities (page 7) 0
Line 8: Name of bank(s) used: none
Affidavit of Committee Treasurer:
I certify that I have examined this report inclu ing ttached schedules and it is, to the best of my knowledge and belief, a toe and complete statement of all campaign finance
activity, including all contributions, loans, rece� s, a enditures, disburseme m-ki contributions and liabilities for this reporting period and represents the campaign
finance activity ofall persons acting under the ant or on belikMo this mutt e' accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury: (Treasurers signature) Date:
FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check I box only)
Candidate with Committee and no activity independent of the committee
I certify that 1 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
Oactivity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. 1 have not received any contributions,
incurred any liabilities nor made any expenditures on my behalfduring this reporting period.
Candidate without Committee OR Candidate with independent activity filing separate report
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 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 persgn"cling 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: I I ( (a ' / d