HomeMy WebLinkAbout2011-12-31-Stewart-OCPFMEMO Form CPF M 102: Campaign Finance Report
Municipal Form
Otnce of Campaign and Political Firume i€ y r
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t
File with
City or Town Clerk or Election Commission
Please print or type all information, except signatures.
Fill in dates: Month Due Ye DW Yea
Reporting Period Beginnin ( ,. i � Ending 7 4 F
Tel. Na (optional)
Tel. No. (optional)
SUMMARY BALANCE INFORMA'
Line 1: Ending balance from previous report
Line 2: Total receipts this period (page 2, line 11)
Line 3: Subtotal nine i plus line 2)
Line 4: Total expenditures this period (page 3 line 14)
Line 5: Ending balance (line 3 minus line 4)
i
$
------------------------------- -- -
Line 6: Total in -kind contributions this period (page 4) $
Line 7: Total (all) outstanding liabilities (page 4) $
Line S: Name of bank(s) use
Afndavk of Committee Tressurer.
I artily that I have examined this report including attached schedules and it it, to the best of my knowledge and belief; a true and complete statement of all campaign
finance activity, including all contribution, loans, receipts, expenditures, disi xtrzanco M k kind contributions and liabilities for this reporting period and represents the
Campaign finance persons acting under the authority or on behalf of this committee in accordance with the requirements ofM.G.L c. 55.
Signed under the penalties of perjury:
signature
FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW)
Anidavit of Candidate: (check 1 box only)
❑ Candidate with Committee and no activity' Independent of the commmittee
I artily that I have examined this report including attached schedules and it is, to the best of my knowledge and belied a true and complete statemerd 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 e. 55. 1 have not received any
contribution, incurred any liabilities nor nude any wpenddUfm on my behalf during this reporting period.
O CAndWate without Committee OR Candidate with Independent settvity filing separate report
I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belied a true and complete statement of all campaign
finance activity, including contributions, loans, 'cats, expeadituas, disbursements, in," contributions and liabilities for this reporting period and represents the
Campaign finance activity f all persons acting the authority or on bdulf of this committee in accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury:
Date
Schedule A: Receipts
Date Received
Name and Residential Address
Amount
11/25/11
Cheryl Meadow, 9 Chase Ave., Lexington, MA 02421
23.97
12/3/11
Harmony Wu, 99 Fairfield Rd, Needham, MA 02492
50.00
12/12/11
Meredith Applegate, 42 Reed St., Lexington, MA 02421
23.97
12/14/11
Susan Schiffer, 6 Moreland Ave., Lexington, MA 02421
96.80
12/18/11
Amy Weinstock, 33 Dawes Rd., Lexington, MA 02421
96.80
Line 11: TOTAL RECEIPTS IN THE PERIOD
291.54
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SCHEDULE A: RECEIPTS
h,I.G.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts
0 1,er $SO.in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
l tvalixe those receipts over $30. In addition, the ucczrpatiori and employer must be reported for all persons who
c'Otitribute $200 or more in a calendar year.
This page may be copied if additional pages are required to report all receipts. Please include your committee name and a page
..1.,., nn rnnh nnae
Date
Received
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
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Line 9: Total receipts in excess of $50 (or listed above)
Enter oil page 1, line 2
Line 10: Total receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD
(' � ^ +��
+ If you have itemized receipts of $50 and under include them in line 9. , me 10 shoU_d include only those receipts not itemized
above, Page 2