HomeMy WebLinkAbout2012-01-17-LexFun-M22Form CPF M22: REPORT OF BALLOT QUESTION EXPENDITURES
BY CORPORATION, ORGANIZATION OR INDIVIDUAL
MUNICIPAL FORM
Commonwealth Office of Campaign and Political Finance
Of Massachusetts
File with: Local Election Official Filing Date: Cl $` day preceding election
El 30` day after election
O January 20`
Please print or type, except signatures.
4. The expenditures below were made to (check one) support / oppose
question number relating to
(if applicable) pp (Describe question Vriefly)
submitted to the x in
(Name of City /Town)
5. Expenditure(s) (attach additional pages if necessary):
Date Paid To Wh Pa id
Address
a
e
(Election Date) ,
Amount or
Value*
Total expenditures on this report a
Total expenditures previously reported
Total expenditures to date /000,
*In -kind contributions should be included here.
OVER
r .
P
_i
Total expenditures on this report a
Total expenditures previously reported
Total expenditures to date /000,
*In -kind contributions should be included here.
OVER
6. Liabilities and promises to pay:
Date Made or
Incurred*
To Whom Due
Address
; Purpose
Amount **
ru
Total liabilities on this report
Total liabilities previously reported and currently outstanding
Total outstanding liabilities
* A promise to pay exists and must be reported if the corporation, organization or individual has (1) made an express or implied
promise to give, pay, expend or contribute money or anything of value or (2) knows or reasonably should know that they will
be responsible for paying for a good or service. A liability exists and must be reported if the corporation, organization or
individual has received a good or service which has not been paid for even if the corporation, organization or individual has
not received a bill or invoice.
** If the amount of the liability has not been determined or is in dispute, the liability should be estimated or reported as "to be
determined" or "in dispute."
I certify that this report is a true statement of the amount or value of every gift, payment, expenditure or contribution or promise to
give, pay, expend or contribute in order to influence or affect the vote on the question referenced on the front of this report,
together with the date, purpose, and full name and address of the person to whom it was made, I make this report in accordance
with the requirements of Massachusetts General Laws, Chapter 55, Section 22, as amended.
Signed under the penalties of perjury:
Signature of cm' 'horation /organization
11) -s
ividual Print Name
Date
3
M.G.L. Chapter 55, Section 22 states in part:
Any person or the treasurer of a corporation, association, organization or other group of persons, other than a political committee organized
tinder section 5, which has given, paid, expended or contributed, or promised to give, pay, expend or contribute, any money or other thing of
value in order to influence or affect the vote on any question submitted to the voters shall file reports setting forth the amount or value of every
gift, payment, expenditure or contribution or promise to give, pay, expend or contribute, together with the date, purpose and full name crud
address of the person to whom it was made.
Any person who makes an expenditure of $250 or more other than a contribution to a ballot question committee or incurs a liability of $250 or
more to influence or affect the vote on any question submitted to the voters shall file reports setting forth the amount or value of the expenditure
or liabililty, together with the date, purpose and full name of the person to whom the expenditure was made or the liability incurred.
If the question appears on ballots at a city or town election or appears on ballots for use in a city or town at a state election, such report shall
be filed with the city or town clerk as follows: (1) the eighth day preceding a preliminary or primary, including a caucus, the eighth day
preceding a city or town election and, if a ciq) election, as a final report, the twentieth day ofdanuary in the following year, complete as of the
thirty-first day of December of the prior year and, if a town election, as a final report, the thirtieth day following such election; (2) the eighth
day preceding a special primary, including a caucus, the eighth day preceding a special election and, as a final report, the thirtieth day
following a special election; and (3) the twentieth day ofJanuary of each year, complete as of the thirty -first day of December of the prior year,
until all declared liabilities ofsuch person or corporation, association, organization or other group ofpersons have been discharged. [Except
for the Jan. 20 report, all reports must be complete as of the preceding tenth day.]
Any person or corporation, association, organization or other group of persons, other than apolitical committee organized under said section
5, violating any provision of this section shall be punished by a fine of not more than $50, 000 and any officer, director or agent of any such
person or corporation, association, organization or other group of persons violating any provision hereof or authorizing any such violation or
any person who violates or in any way knowingly aids or abets the violation of any provision hereof shall be punished by a fine of not more than
$10,000 or by imprisonment for not more than one year or by both such fine and imprisonment.
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