HomeMy WebLinkAbout2012-04-06-McCabe-OCPFForm CPF M 102: Campaign Finance Report
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Municipal Form ��F! L ! g ar 2: r;
Once of campaign and Polittcat Finance
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File with:
City or Town Clerk or Election Commission
Please print or type all information, except signatures.
Fill in dates: Month Dde Y ew Month Dete Y ew
Reporting Period Beginnin P� ,C,;? ''2 0 / Ending 17PF f b ✓ 17—
Type of report: (Check one)
08th day preceding preliminary 08th day preceding election 030 day after election -Elyear�nd report ® lution J
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Full Name of Candidate (if applicable)
Office Sought and District
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Residential Address
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Tel. No. (optional)
Committee Name
Name of Committee Treasurer
Committee Mailing Address
Tel. No. (optional)
SUMMARY BALANCE INFORMATION:
Line 1: Ending balance from previous report $
Line 2: Total receipts this period (page 2 line 11) $ f
Line 3: Subtotal pine 1 plus line 2) $
Line 4: Total expenditures this period (page 3 line 14) $ 7 !"
Line 5: Ending balance pine 3 minus line 4) $
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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) used - 7-tems
Affidavit of Committee Treasurer.
1 artify that I have examined this report including attached schedules and it is, to the lest of my knowledge and belief, a true and complete dateme:n of all campaign
finance activity, including all contributions, loans, receipts, expenditures, disbursements, ire -kind contributions and liabilities for this reporting period and represents the
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campaign aMCe V" of all acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. SS.
r Signed under the penalties of perjury: / I/// /J '
Treseorer's signature
: (CANDIDATE MUST SIGN BELOW)
Afndavit of Candidate: (check 1 boa only)
❑ Candidate with Committee and no activity independent of the committee
I certify that I have examined this report including attached schedules and it is, to the bed of my knowledge and belief a true and complete statement 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.O.L. e. 33, h have not received any
oomributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period.
❑ Candldate without Committee OR Candidate with Independent activity Ming separate report
1 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 statrneM of all campaign
finance activity, including conlributiom loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the
vampai activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. S S.
Signed ' er the penalties of perjury:
Candidate signature (in ' ) ate
SCHEDULE A: RECEIPTS
kf,G.L. c. SS requires that the name and residential address be reported, in alphabetical order, for all receipts
Over $50. in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only
lt those receipts over $30. In addition, the occupation and employer must be reported for all persons who
et)Iltribute $200 or more in a calendar year.
Phis page may be copied if additional pages are required to report all receipts. Please include your committee name and a page
mber on each page.
nu
Date
Received
Name and Residential Address
(alphabetical listing required)
Amount
Occupation & Employer
(for contributions of $200 or more)
7q
Line 9: Total receipts in excess of $50 (or listed above)
0 Enter on page 1, line 2
1n ..0 ..id 0 ..1...1e ..,,1., th— rPPPinta not itpMi7
Line 10: Total receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD
-- __
"7
:__ n 7 :
* If you have itemized receipts of S50 and under include them 111 litre 7, LiL�. av auvuau .,..,.— .. ..,y .............._.
above. Page 2
ed
SCHEDULE B: EXPENDITURES
M.G.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
number on each DaRe.
Date Paid
To Whom Paid
(alphabetical listing)
Address
Purpose of Expenditure
Amount
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- /x L
711
Enter on page 1, line 4
Line 12: Expenditures over $50
Line 13: Expenditures $50 and under*
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
SCHEDULE C: "IN- KIND" CONTRIBUTIONS
Please itemize contributors who have made in -kind contributions of more than $50. In -kind contributions $50 and under may be
added together from the committee's records and included in line 16.
Date
Received
From Whom Received*
Residential Address
Description of
Contribution
Value
Enter on page 1, line 6
Line 15: • In -kind over $50
Line 16: In -kind $50 and under
Line 17: Total In -kind
Line 18: OUTSTANDING LIABILITIES (ALL)
* If an in -kind contribution is received from a person who contributes more than $50 in a calendar year, you must report the name
and address of the contributor; in addition, if the contribution is $200 or more, you must also report the contributor's occupation and
employer.
SCHEDULE D: LIABILITIES
M.G.L. c. 55 requires committees to report ALL liabilities which have been reported previously and are still outstanding, as well as
those liabilities incurred during this reporting period.
Date
Incurred
To Whom Due
Address
Purpose
Amount
Enter on page 1, line 7
Line 18: OUTSTANDING LIABILITIES (ALL)
This page may be copied if additional pages are required to report all activity. Please include your committee name and a page
number on each page `�� printed on recycled paper Page 4