Form CPF M 102: Campaign Finance ReportMunicipal Form

Officeof Campaign and Political Finance

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City or Town Clerk or Election Commission

Please print ortype all information, except signatures.

Fill in dates: Mm*Reporting Period Beginning f I

Yat Mcmh

_Ending I 2- 3 IYe*

So M

Type of report: (Check one) .D8th day preceding preliminary D8th day preceding election D30 day after election 0y«lyear-end report Ddissolution

s\&arJcKi<\ 9-e.HrCvi j MeFull Nameof Candidate(if applicable)

/ ^ aC[±u Co o^cHo r} OWX"Office Sought and District

°\1 P/Aa^H i4,h> Luim

Committee Name

Name of Committee Treasurer

Committee Mailing AddressResidential Address rHMt

TeL No. (optional) TeL No. (optional)

SUMMARY BALANCE INFORMATION:Line 1: Ending balance from previous reportLine 2: Total receipts this period (page 2, line 11)Line 3: Subtotal (line 1plus line 2)Line 4: Total expenditures this period (page 3, line 14)Line 5: Ending balance (line 3minus line 4)

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 Fu^k/a Ks^ L_

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Affidavit of Committee Treasurer:

Icertify tbtUIluve eaniined Ite report including attached schedules and it is, to the best ofmy knowledge and belief, atrue and complete statement ofall campaignfinance activity, including all contributor*, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represerTthccampaign finance activityofallpersons acting underthe authxxity oronb<halfof thisccrnrmtteem accordance w^

Signed under the penalties of perjury:

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Date

FOR CANDIDATE FILINGS ONLY: (candidate must sign below)

Affidavit ofCandidate: (check 1 box only)• Candidate withCommittee andnoactivity independent ofthecommitteejcertify that Ihave examined this report tociudtog attached schedules and fc is, to the b^finance activity, ofall persons acting under the authority oron behalfofthk ccrnrnittee to accordarx* wta the requ^^ Ihave not received anycontributions, incurred any habiliucs nor made any expentlhures onmy behalfciiring this reporttogQCandidate without Committee OR Candidate with independent activity Clint separate reportI certify that I hayc examined this report tocludtog attached sdiedules ar^itis, tothe best o^finance activity, including contributions, loans, receipts, expenditures, disbursernents, in-kind contributions and liabilities for this repotting period and represents theounpaignfinance ndivny ofalljxrsons acting under the authority oron behalfofthis committee to accordance with the requirements ofM.G.L. c. 55.

Signedunder the penalties of perjury:

MS^ Date'