HomeMy WebLinkAbout2012-02-27-Kelley-OCPFM
Form CPF M 102: Campaign Finance Report
Municipal Form.
office of Campaign and Political Finance
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File with: l ''
City or Town Clerk or Election Commission [J" . 1 `��
Please print or type all information, except signatures.
Fill in dates: Month DW Yar Mach Dots Yea
Rep Period Beginnin i O) Ending
Type of report: (Check one)
08th day preceding preliminary 48th day preceding election 030 day after election 0year - end report ❑dissolution
Full Name of Candidate (if applicable)
Office Sought and District
3 re c'-"A ' " —
Residential Address
� 1- Lt 1
Tel. No. (optional)
Tel. No. (optional)
SUMMARY BALANCE INFORMATION:
Line 1: Ending balance from previous report $
—I - _ ; r
Line 2: Total receipts this period (page 2 line 11) $_, ;
Line 3: Subtotal pine 1 plus line 2) $
Line 4: Total expenditures this period (page 3 line 14) $ C
Line 5: Ending balance pine 3 minus line 4> $ t "
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Line 6: Total in -kind contributions this period (page 4) $
Line 7: Total (all) outstanding liabilities (page 4) $
Line 8: Name of bank(s) use
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Affidavit of Committee Treaaarer.
I certify that I have examined this report including attached schedules and it is, to the bat of my knowledge and belief, a true and complete atatemen of all campaign
finance activity, including all contributiom, loam, receipts, expenditures, disbunar ants, irrkind contributions and liabilities for this reporting period and represents the
carpaign finst nce activity of all pecan 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:
(in ink) — Data
FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW)
Affidavit of candidate: (check 1 box only)
❑ Candidate with Committee and no activity independent or the committee
I catify that I have examined this report including attached schedules and it ice, to the best of my knowledge and belied a true and complete statement of all campaign
finance activity, of ail persons acting under the authority or on behalt'of this committee in accordance with the requirements of M.O.L c. 55. 1 have not received any
contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting Period.
O Candidate without Conunklee OR Candidate with independent activity filing separate report
I army that I have examined this report including attached schedules and it is, to the best of my knowledge and belief; a true and compile statement of all campaign
finance activi , including contributions, loam, rcceipts, expenditures, disburser rats, in -kind contributions and liabilities for this reporting period and represents the
campai f activity of all persons acting under the authority or on behalf of this co nmittee in accordance with the requirements of M.G.L a 55.
Signed under the penalties of perjury:
Ahran/, 1
Committee Name
Li -r. tLU7 _ S
Name of Committee Treasurer
Committee Mailing Address
-) v ` 4o i f,
Date
SCHEDULE B: EXPENDITURES
MG. 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 $50 and under may be added together, from committee records, and reported on line 13.
This page may be copied if additional pages are required to report all expenditures. Please include your committee name and a page
*If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not
itemized above. Page 3