HomeMy WebLinkAbout2018-11-26-Bokun-OCPF Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
MUNICIPAL FORM
Commonwealth Office of Campaign and Political Finance
of Massachusetts Zola gQV 26 Ed, '
File with: City 1 Town Clerk or Election Canmission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amended,of then i a oti a
candidate's committee as follows:
CANDIDATE: Full Name:
Residential Address: r�-t c iA y
City I State I Zip: � � Y
r ��
E-Mail Address: . ; rr-A'i. C, �a� ` CttL V, Phone#; € fv � �
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Title: C% r,L L,)` i
District: ? t otlG
COMMITTEE: Name of Committee:
(The name of the committee must include the candidate's last name)
f
Committee Mailing Address:
Phone#:
City l State I Zip: Z_X IAIC_�- S 7 F
i
OFFICERS:
Chairman: ti y�
r� . TreasuA
0
Residential Address: Residential
_
City 1 State I Zip: L G fAk 0,'L4.,Lo City/State l Zip: �/ r �'
Phone#:(Dn-(.V'\. ��� . Phone#: �1 `� �� t. ��.fGX' Ll i
*A public employee may not serve as treasurer of any political committee see reverse)-.
i
Other Officer/Title: Luh ��H _ K r Other OfficerlTitte:
Residential Address:_ 180 �- Residential Address:
r
City/State 1 Zip: � Jil ZA�> City!State 1 Zip:
Phone#: $f •(�3'L 2Z�;q� Phone#:
(Complete and attach a Forin CPF M A 101,if necessary,with other officers and finance committee,if any.)
I hereby consent to the tiling of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her
behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY: "" -
`'..-�/, Date: i llz-(_- f
Candidate's signature
I hereby accept the office of Treasurer of the above-named committee.I affirm that I am not a public employee as defined by M.G.L.c.55,s. 13.I understand
that: 1)I am subject to certain duties and liabilities under M.G.L, 55—, melutdi1.�the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of si• ears from the dat`e�f the relevant election;2}if after my acceptance of this office I become an
appointed public employee,I must resign this position and n tify OCPF of to resigna n;and 3)a candidate may not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED UNDER THE PENALTIES OF PERJURY; Date:
TCca ! F's atut
I hereby accept the office of Chairman of the above-named committee,
SIGNED UNDER THE PENALTIES OF PERJURY:
Chairman's sign r Data:�. ��