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HomeMy WebLinkAbout2011-02-25-Embry-OCPFForm CPF M 102 -0: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Coao�wonwaph , of Mauachuunt City or Town of: LZ5X1A17 /O/L-/� Please print or type all information, except signatures. Fill in dates: Month Day Year Month Day Year Reporting Period Beginning / / 1 20/0 Ending )— ! r Z / Type of Report: (Check One) r-1 8th day preceding 1 j° 8th day preceding election 13 30th day following election 20th day of January preliminary/primary (Town or Special) (Y ear -End Report)' Pursuant to M.G.L., Chapter 55: 1. I certify that I am a candidate for or hold Municipal Office, 2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this reporting period, and do not have a campaign fund in existence. 3. I certify that I do not have a political committee, DATE I. SIGNATURE Signed and -the enalties of perjury II. RESIDENTIAL ADDRESS (Street and Number) III, OFFICE SOUGHT 4,1� 15©s�,,) N rn -f V ' $f M N � W ij