HomeMy WebLinkAbout2019-01-07-Burson-OCPF Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
MUNICIPAL FORM
Commonwealth Office of Campaign and Political Finance
of Massachusetts n l•
File with: City I Town Clerk or Election Commission
NOTICE I5 HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as atnet�d c INJ o, apizat}on of a
candidate's committee as follows: ' 3 11, M A
CANDIDATE: Full Natne: o !J 4k
Residential Address: , y V
City/State I Zip: l Axl u. e^r fn {�' 0_&i
E-Mail Address: �' GZ�o��e 2,T Z j 6 �� ' C%G7 Phone#: �j l o
-�.- '" €^
Party Affiliation: y1,,o C r( (If applicable)
OFFICE SOUGHT/PURPOSE: f 1
Title: rt r�f�C t YVI
District: "i I'D yy Z,
COMMITTEE: Name orCommittee: /� a 1F� So fi
e (The name of the committee must include the candidate's last name)
Committee Mailing Address:
City 1 State/Zip: Phone#: ��) 4 ��--2J O
� r
OFFICERS:
Chairman: �� S d Treasurer*: I-<O
Residential Address: S �' � ) j� 7 / Residential Address: lew
City I State I Zip: ��� l ZG 1 City I State I Zip:
Phone#: �� �' `' �� Picone#:
*A ublic employee may not serve as treasurer of any political g&nmittee see reverse).
Other Officer/Title: Other Officer/Title:
Residential Address: Residential Address:
City 1 State/Zip: City 1 State 1 Zip:
Phone#: Phone#:
(Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,if 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 11 campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY: �
Date:
Candidate's sf nature
I hereby accept the office of Treasurer of the above-named comtmitte 4 ffirm that I am not a public employee as defined by M.G.L,c.SS,s. 13.I understand
that: 1}I am subject to certain duties and liabilities under M.G.L. . ,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:
f Bate:
Treasurer's sign e ��
I hereby accept the office of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
Date:
Chai ris signature