HomeMy WebLinkAbout2012-04-06-Kelley-OCPFForm CPF M 102: Campaign Finance Report
Municipal Form
O m ce of campaign and Political 17hume
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File with:
City or Town Clerk or Election Commission
Please print or type all information, except signatures.
Fill in dates: morA Due Yam Mont Due Yea
Reporting Period Beginnin .J I e Ending �f r: c 0 ,-
Type of report: (Check one) /
08th day preceding preliminary 08th day preceding election 30 day after election 0year -end report ❑dissolution
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Tel. No. (optional)
Tel. No. (optional)
SUMMARY BALANCE INFORMATION:
Line l: Ending balance from previous report $ J�i(� . 7
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) $
Line 5: Ending balance pine 3 minus line 4) $ I C) 1 L
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Line 6: Total in -kind contributions this period (page a) $
Line 7: Total (all) outstanding liabilities (page 4) $
Line 8: Name of bank(s) used
Affidavit of Committee Treasurer.
I ca* that I have examined this report including attached schedules and it is, to the beat of my knowledge and belief, a true and complete sutement of all campaign
finance activity, including all contributions, loans, receipts, expenditures, disbunanana, in-kind contributions and liabilities for this reporting period and represents the
campaign finance activity of all persons acting under the authority or on bch&Wof this committee in accordance with the requirements of M.G.L a SS.
Signed under the penalties of perjury:
Treasurer's signstare (in ink)
FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW)
Atlldsvit of Candidate: (check I box only)
O Candidate with cormnitlee and two activity Independent of the committee
I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign
finance activity, of all persons acting wrier the authority or on behalf of this committee in accordance with the requirements of M.G.L a 33. I have not received any
contributions, incurred any liabilities nor nude any expenditures on my behalf during this reporting pence
C Candidate without Committee OR Candidate with Independent activity flung separate report
I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief; a true and complete statement of all cannpaign
finance actt nxsl cotributiau, loans, receipts, expenditures, disbursements, in*ird contributions and liabilities for this reporting period and represents the
nxrrtpaign f adi f all ! , acting under the authority or on behalf of this convnittee in accordance with the requirements of M.G.L. o 55,
ra � under the penalties of perjury:
SCHEDULE B: EXPENDITURES
M.G.L. c. SS 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
number on each page.
Date Paid To Whom Paid Address Purpose of Expenditure Amount
(alphabetical listing)
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Line 12: Expenditures over $50
Line 13: Expenditures $50 and under*
Enter on page 1, line 4 Line 14:TOTAL EXPENDITURES
*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