HomeMy WebLinkAbout2018-12-31-Jay-OCPF r
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Municipal Form
0 ke of Campaign and Political Fitrance
Commonwealtht .q 22 "` 1
of Massaehusctts `� " � t �)
Dile with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: LE ;' 't a `x IU c�t c c+r trading Date:
Type of Report: (Check. one)
❑ Sth day preceding preliminary ❑ Sth day preceding election ❑ 30 day aper election year-end report ❑ dissolution
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Candidate Ful]'Nonte(if applicable) Committee NameL-
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Office Sought and Di5lriel Mame of Committee Treasurer
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Residential Address Committee Mailing Address
I'cicphonc lumber(optional): fetcphone Number(optional):
SUIVIMARY BALANCE INFORMATION:
Line I: Ending Balance from previous report J ��
Line 2: Total receipts this period (page 3, line 1 1)
Line 3: Subtotal (line 1 plus line 2) 2-0
Line 4: Total expenditures this period (page 5, line 14)
Lane 5: Ending Balance(line 3 minus line 4)
Line 6: Total ire-kind contributions this period(page 6)
Line 7: Total (all) outstanding liabilities (page 7)
Line 8: Name of bank(s) used: ('. ; Z F'-/')=3 fj A-,mss
Affidavi(of Connmittee Treasru•er:
I certify Haat I have e.xamined this report tnckad'€ng atlached sche(itiles and it is,to the best of my katowledge and belief,a true and complete statement of all campaign finance
activity,including all contributions,loans,receipts,expenditin es,disbit senents,in-kind contributions and Liabilities for this repotting period and represents the campaign
finance activity of all persons acting tulder the autliority or on behnit-of this committee in accordance with the requirements of M_G.L,c.55_
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Signed under the penalties of perjury: -,— -- -�� ' {'I reasttrer s signature) D71te: ZQ J
FOR CANDIDATE FILINGS ONLY, affidavit of Candidate:(check t box only)
Candidate with Comndttec and no activity indepeudcut of the committee
I certify that 1 have examined this report including attached schedules and it is,to the hest of my knowledge and belief,a true and complete statement of all campaign finance
activity,of all persons acting tutdcr the authority or on behalf of this committee in accordance with the regsritetnenis of M.G.L.c.55, 1 have not received any contributions,
incltrrcd any liabilities nor made any cxpendintres oil airy behalf during this reporting peaiod.
Candidate without Committee OR Candidate with independent activity filing separate report
❑ I certify that I have examined thus report including attached schedrtles and it is,to the best of my knowledge and belief,a true and complete statement of alI campaign
final€ce activity,including contributions,loans,receipts,expenditures,disbirrsemen€s,in-kind contributions and liabilities for this reporting period and represents the
c<9mpaign finance activity of all persons acting tinder the authority or on behalf of this committee in accordance with the regisirentcots of M.G.L.c.55.
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h1.G.1.. r., 55 requires Ihal the trrrrue rntr(i€atirlcvtllId address he reported, in alplraNtic.al order,for rxll receirAY over$50 in aealendur
ccordc ofall receipts, bul tjeed onIV itemize Mose receipts over$50. �Iri iidditiort, the
year. Cotruuittnev t7u-1sf fie,�p rleicaiirrd rrccouxLs rstuJ r
occupation awl evtpl?y)ev ttrust he repor ied/ns•all contribute$200 or inorc,irr a calcznek"'year.
(A"Schedule A. i2cce.iprtw" srtt:te:iata:crrt i sa�.ailsalale w€a nipletc,print and attaela to this report,if.additional pa;eN are required to
report ail rcceiltts_ PICFI.w h1cludc Your c(rraar)a'sftcc narnas and a paage-eatartaber on each[)rage,)
N ilnic and R€bidexil.i<al Address Occupation& Employer
Date Reecive€t r•c( ssare€i)
Amount (for contributions`of$200 or more)
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Linc 9;'frtai l:eccihts ovct-'G50 (or iis(cci sibove)
Line 10: Too at Rcc,c,ihts$50 and undcv- (nol. lis d abovtO
Line 11: 'I'OTA1, Rt?:CEIPTS Ili THE 191?RNOD � Eutcr ou page 1, line 2
1f you have itcrnizeci re.ecipi s or s5o asxl incw(k tbeni in line 1). .L.ine 10 should inciting only thosc receipts riot itemized above.
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To Whom Paid
Date Paid (alphabetical listing) Address Purpose of Expenditure Amount
Line 12: Expenditures over$50 (or listed above)
Line 13: Expenditures$50 and under* (not listed above) J
Enteron pale 1, line 4 > Line 14: TOTAL EXPENDITURES IN TTIE PERIOD
I£you have itemized expenditures of$50 and under, include them in line 12. Line 13 should include only those expenditures not itemized
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