HomeMy WebLinkAbout2018-04-05-Hai-OCPFForm CPF M 102: Campaign Finance Report
Municipal Form
uV Office of Campaign and Political Finance
Commonwealth
of Massachusetts
File with: City or Town Clerk or Election Commission
Fill in Reptifting Period' dabs:' `i Beginning Date: 02/20/2018 Ending Date: 03/25/2018
Type of Repofit. (Check one)
❑ 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
Office Sought and District
6 Highland Avenue, Lexington, MA 02421
Residential Address
Telephone Number (optional): (781) 862-3776
Lill Hai for Selectman
Committee Name
Jodi R. Galin
Name of Committee Treasurer
P.O. Box 248, Lexington, MA 02420
Committee Mailing Address
Telephone Number (optional): (781) 910-4681
SUMMARY BALANCE INFORMATION:
Line l: 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)
�— 1,8s8.2s
VI
1,888.28
1,022.44
Line 5: Ending Balance (line 3 minus line 4) ` 865.841
Line 6: Total in-kind contributions this period (page 6) 1
Line 7: Total (all) outstanding liabilities (page 7) 0
Line 8: Name of bank(s) used: citizens Bank
certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a tine and complete statement of all campaign finance
ctivity, 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 f thi coin ittee in accordance with the requirements of M.G.L. c. 55.
ligned under the penalties of perjury:-�w�'VV r i� (Treasurer's signature) Date:--F-—w
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 tine 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 riling 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 tine mrd 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 ogling 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:16.1 19 S 2
SCHEDULE A: RECEIPTS
M.G.L. c. 55 requires that the name and residential address be reporter,, 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)
L�
F
---
_771
F-1
F
Line 9: Total Receipts over $50 (or listed above)
F Enter on page I, line 2
Line 10: Total Receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS 1N 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)
O
-771
Line 9: Total Receipts over $50 (or listed above)
E Enter on page 1, line 2
Line 10: Total Receipts $50 and under* (not listed above)
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
MG.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 in a reportingperiod Committees must keep
detailed accounts and records ofall 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
renort all expenditures. Please include your committee name and a page number on each page.)
* 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
To Whom Paid
Date Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
03/21/2018
Chinese American
Lexington (CAAL) Association of
P.O. Box 453
Lexington, MA 02420
Advertisement
288
03/05/2018
Colonial Times Magazine
805 Massachusetts Avenue
Lexington, MA 02420
Advertisement
525
02/22/2018
Lexington Graphics, Inc.
76 Bedford Street
Lexington, MA 02420
Signs
77.56
02/26/2018
Lexington Graphics, Inc.
76 Bedford Street
Lexington, MA 02420
Signs
31.88
03/01/2018
Dawn McKenna
9 Hancock Street
Lexington, MA 02420
Town Election Watch Event
100
F7=
Line 12: Total Expenditures over $50 (or listed above) 1,ozz.44
Line 13: Total Expenditures $50 and under* (not listed above)
Line 14: TOTAL EXPENDITURES IN THE PERIOD
1,022.44
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 expenditures not itemized
above. Page 4
SCHEDULE B: EXPENDITURES (continued)
Date Paid
To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
-- —
—
F71
F
I
[
--E
Enter on page 1, line 4
Line 12: Expenditures over $50 (or listed above)
Line 13: Expenditures $50 and under* (not listed above)
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.
Received I From Whom Received* I Residential Address
of Contribution Value
__:1
F E_
Line 15: In -Kind Contributions over $50 (or listed above)
Line 16: In -Kind Contributions $50 & under (not listed above)
Enter on page 1, line 6 � I Line 17: TOTAL IN-KIND CONTRIBUTIONS
* 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 reportingperiod.
Date Incurred
To Whom Due
Address
Purpose
Amount
E7
1
F- IF
71=
Enter on page 1, line 7
Line 18: TOTAL OUTSTANDING LIABILITIES (ALL) f o =
Page 7