HomeMy WebLinkAbout2011-12-31-Embry-OCPFForm CPF M 102-0: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
of Mwuhuxtu
City or Town of
Please print or type all information, except signatures.
Fill in dates: Month
Day
Year
Month
Day,
Year
Reporting Period Beginning
Ending
/ -K
Type of Report: (Check One)
8th day preceding 8th day preceding election 0 30th day following election 20th day of January
prelim inary/primary (Town or Special) (Year-End Report)'
Pursuant to M.G.L,, Chapter 55:
1, 1 certify that I am a candidate for or hold Municipal Office.
2. 1 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. 1 certify that I do not have a political committee.
DATE
1. SIGNATURE
Signed under the p
h .0nalties of perjury
11. RESIDENTIAL ADDRESS
(Street and Number)
III. OFFICE SOUGHT
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