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Home My WebLink About2018-02-26-Hai-OCPFa�l Form CPF M 102: Campaign Finance Report Municipal Form uV Office of Campaign and Political Finance Commonwealth of Maecachnsetts File with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: of/0l/2ols Ending Date: 02/19/2018 Type of Report: (Check one) — rt —+ ❑ 8th day preceding preliminary 8th day preceding election ❑ 30 day after election ❑ year-end report [ dissolution Jill I. Hai Candidate Full Name (if applicable) Selectman Lexington, MA Office Sought and District 6 Highland Avenue, Lexington, MA 02421 Residential Address Telephone Number (optional): (781) 862-3776 Jill Hai for Selectman CommitteeName Jodi R. Galin •• Nameof Committee Treasurer U-, P.O. Box 248, Lexington, MA 02420 Committee Mailing Address Telephone Number (optional): (781) 910-4681 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) 2,169.11 100 2,269.11 380.83 Line 5: Ending Balance (line 3 minus line 4) 1 1,888.281 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 sank Affidavit of Committee Treasurer: I certify that I have examined this report including attached schedules and itis, 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. \ d Signed order the penalties of perjury: LLL4� �( A �V- �t7 (Treasurers signature) Date: �� I ei t FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 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 activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L.. a 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. ! r (Candidate's signature) Date: Signed under the penalties of perjuryr I q I t 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 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 renort all receints. Please include your committee name and a page number on each page.) Date Received F01/16/20718]18 Name and Residential Address (alphabetical listing required) Anne Groves Winthrop i th RadMA Amount 100 Occupation & Employer (for contributions of $200 or more) op F-7 F rTr—t Jzi- 71 lr FF 100 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 100 * 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) F O=.-I O --71 F:77-7=- Line 9: Total Receipts over $50 (or listed above) F Enteron page 1, line 2 Line 10: Total Receipts $50 and under* (not listed above) F7= Line 11: TOTAL RECEIPTS IN TRE PERIOD I �] * 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, 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.) To Whom Paid Date Paid (alphabetical listing) Address Purpose of Expenditure Amount 01/03/2018 Staples 80o Lexington Street Stationary Waltham, MA 02451 L981-81 01/16/2018 [United States Postal Service 1661 Massachusetts Avenue Lexington, MA 02420 PO Box 248 82 L 1/10/2018 Lexington Graphics, Inc. 76 Bedford Street Lexington, MA 02420 Thank you notes Flyers 200.02 01/03/2018 Staples 80o Lexington Street Stationary Waltham, MA 02451 L981-81 01/16/2018 [United States Postal Service 1661 Massachusetts Avenue Lexington, MA 02420 PO Box 248 82 L _I f� Line 12: Total Expenditures over $50 (or listed above) 3so.s3 Line 13: Total Expenditures $50 and under* (not listed above) I—®I Enter on page 1, line 4 � I Line 14: TOTAL EXPENDITURES IN THE PERIOD L— * If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not above. 380.83 Page 4 SCHEDULE B: EXPENDITURES (continued) To Whom Paid Pnrnnse of F.rnenditure Amount L_I Line 12: Expenditures over $50 (or listed above) Line 13: Expenditures $50 and under* (not listed above) Enter on page 1, line 4 - I Line 14: TOTAL EXPENDITURES IN THE PERIOD * 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-KIND" 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. .. _•___,I wr.,.—..n,...,...A* IRncidan4ialAddrpss IDescrintlonofContributionl Value ate neceercu r --- 'N'. Line 15: In -Kind Contributions over $50 (or listed above) 16: In -Kind Contributions $50 & under (not listed above) Enter on page I, line 6 � I Line 17: TOTAL IN-KIND CONTRIBUTIONS I_ * 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. 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. Date Incurred To Whom Due F7771 Address F7-7 I Purpose F--- I Amount F-1 F 711 L Eli F I F- IF F- 1 F-----71 F----71 I F-7= F= F- F- F- F -1- F 7= F - ----: I I F--= F-= 171. I I F := E7:= Enter on page 1, line 7 - Line 18: TOTAL OUTSTANDING LIABILITIES (ALL) Page 7