HomeMy WebLinkAbout2018-11-30-Cohen-OCPF Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
MUNICIPAL FORM _ f
co„mr„onwealth Office of Campaign and Political Finance
of Massachuscits 2018 NOY 3 3 AN 9., 20
Filc+villi: City/Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with therovisions of General Laws,Chapter 55,as amended,of the or t ra t �� t
P P la�m�$��' � M A
candidate's committee as follows:
CANDIDATE: Full Name: C,
Residential Address: 2 Gi
City I State/Zip: �tt k r , �
E-Mail Address, CQ Lt e.11 �� �h r-vC 3 t 5`'`S : C' , e�t Phone#: -i . 0 2
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Title: G-
District:
COMMITTEE: Name of Committee: 41--t t TT~ee I, C� { vl
(The name of the committee must include the candidate's last name)
Committee Mailing Address: � �_
City I Stele l Zip: k i z +-• 07 LI Q.{ Phone
OFFICERS:
Chairman: 1�4 t a� (' , _�, Treasurer*:
TL_
Residential Address:2 Gr Residential Address: "2
City/Slate/Zip: L� iX i P� t-� f`4 /0 V-l 2( City/State/Zip: r ^` -y
Phone#: 77( (1`JA Z Phone#C 7g -ry . �gy'�Enmail: ” f— oto�'! !�G.'I C �
*A ublic employee inay not serve as treasurer of any political cominittea see reverse).
Other Officer/Tide: Other Officer/Title:
Residential Address: Residential Address:
City I State I Zip: City!State 1 Zip:
Phone#: Phone#:
(Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,i f any.)
I hereby consent to the filing 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:
r.._. Date: ( d
3
Candida 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.c,55,including the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of six years from the date of the relevant election;2)if after my acceptance of this office I become an
appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED UNDER THE PENALTIES OF PERJURY: MM Date: 1 a
Treasurer' ignature
T hereby accept the office of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
. ( +
Date: jj
Chairman's ignature
t o !