HomeMy WebLinkAbout2019-01-04-Weiss-OCPF !LIN Form CPF M1.01: STATEMENT OF ORGANIZATION
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CANDIDATE'S COMMITTEE
MUNICIPAL FORM
Commonwealth Office of Campaign and Political Finance
of Massachusetts
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File with: City I Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amended,of the W�iizat t of�k
candidate's committee as follows: t I E
CANDIDATE: Full Name: 9 �r
Residential Address:
City/State I Zip: L ca__ r 1 t O
E-Mail Address: , b(_0 Phone#: 7I
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE-
Title:
District:
COMMITTEE: Name of Committee: ! 6 / .
1,.. _ ` 1 t
(The name of the committee must include the candidate's last name)
Committee Mailing Address: �,( J1
City I State 1 Zip: �J, ,�d Phone#:
OFFICERS: ( f
Chairman: Treasurer*: Ham 6t
Residential Address:
J Residential Address: 1W,
Cityl State I Zip: t � ial 11—pt �c City I State I Zip: ��t Y �7j} /� ' 44-4 4414 02—q I#: 7,1-f �5_6 UL Phone#: j IO-Cy_7 mail: [ tji rGbtQ i r� GA C(/YL.
*A vublic employee may not serve as treasurer of any polii1cal committee see reverse
Other Officer/Tide: Other Officer/Title:
Residential Address: Residential Address:
City I State I Zip: City I State I 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 all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY: j
-; Date:
L 1 (
Candidate's signature 1
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: (�GG U _ Date: 117,11
Treasurer's signatu e
I hereby accept the office of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
Chairman's signature� Date' f I