HomeMy WebLinkAbout2010-12-13-Cohen-OCPFForm CPF M 102: Campaign Finance Reo�t
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Commonwealth Municipal Form L!
of Massachusetts ?011 J A N �� `4
Office of Campaign and Political Finance
AM /I: 18
LE N
File with:
City or Town Clerk or Election Commission
Reporting Period - Beginning: 1/1/2011
Type of report: Year -end
1/3/2011
Ending: 12/31/2011
Norman Cohen Norm Cohen for Selectman
Full Name of Candidate Committee Name
Selectman /Lexington Alice M Pierce
Office Sought/ District Name of Committee Treasurer
3 Captain Parker Arms #24 17 Volunteer Way
Lexington, MA 02421 Lexington, MA 02420
Residential Address Committee Address
SUMMARY BALANCE INFORMATION
Ending Balance from previous report:
Total receipts this period:
Subtotal:
Total expenditures this period:
Ending Balance:
$569.48
$0.00
$569.48
$0.00
$569.48
Total inkind contributions this period:
Total outstanding liabilities:
Name of bank(s) used: TD Bsnk
$0.00
$0.00
Affidavit of Committee Treasurer:
I certify that I have examined this report, including attached schedules and it is, to the best of my knowledge and
belief, a true and complete statement of all campaign finance activity including all contributions, loans, receipts,
expenditures, disbursements, inkind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the authority or on behalf of this committee in accordance with the
requirements of M.G.L. c. 55.
Signed under the penalties of perjury:
i
Treasurer's signature (in ink) Date
Affidavit of Candidate (check 1 box only)
H Candidate with Committee and no activity independent of the committee
I certify that I have examined this report, and attached schedules and it is, to the best of my knowledge and belief, a
true and complete statement of all campaign finance activity, of all persons acting under the authority or on behalf of
this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions, incurred
any liabilities nor made any expenditures on my behalf during this reporting period.
El Candidate without Committee OR candidate with independent activity filing separate report.
I certify that I have examined this report and attached schedules and it is, to the best of my knowledge and belief,
a true and complete statement of all campaign finance activity including contributions, loans, receipts, expenditures,
disbursements, inkind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the authority or on behalf of this committee in accordance with the
requirements of M.G.L. c. 55.
Signed under the penalties of perjury:
�il/ � e n�
Schedule A: Receipts
M.G.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts
over $50 in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
itemize those receipts over $50. In addition, the occupation and employer must be reported for all persons
who contribute $200 or more in a calendar year.
Date Name and Residential Address Amount Occupation and Employe
Total Itemized Receipts
Total Unitemized Receipts
Total Receipts
$0.00
$0.00
$0,00
ry
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Schedule 8: Expenditures
M.G.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 in a reporting period
Committees must keep detailed accounts and records of all expenditures, but need only itemize those over $50.
Expenditures over $50 and under may be added together from committee records, and reported on line 13.
Date Name and Address
Amount
Total Itemized Expenditures $0.00
Total Unitemized Expenditures $0.00
Total Expenditures $0.00
Purpose
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Schedule C: "Inkind" Contributions
Please itemize contributors who have made inkind contributions of more than $50. In -kind contributions $50 and
under may be added together, from the committee's records, and included in line 16. An exception to this is that
all contributions (under or over $50) given by persons who have contributed more than $50 in the calendar year
must be itemized. Please report the names and addresses of contributors. Also give the occupation and employer
of any contributor who has given an aggregate amount of $200 or more in the calendar year.
Date Name and Residential Address
Total Itemized Inkind Contributions
Total Unitemized Inkind Contributions
Total Inkind Contributions
Value Description
Occupation /Employer
$0.00
$0.00
$0.00
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Schedule D: Liabilities
M.Q.L. c. 55 requires committees to report ALL liabilities which have been reported previously and are still
outstanding, as well as the liabilities incurred during this reporting period.
Date To Whom Due
Total Outstanding Liabilities
Amount Purpose
$0.00
X 0
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