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Bender SteveSCHEDULE C: "IN- KIND" CONTRIBUTIONS Please itemize contributors who have made in -kind contributions ofmore than $50. In -kind contributions $50 and under may be addedtogetherfromthecommittee'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 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 andemployer. SCHEDULED: LIABILITIES M.G.L. c. 55 requires committees to report ALL liabilities which have been reportedpreviously and are still outstanding, as well asthoseliabilitiesincurredduringthisreportingperiod. 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 numberoneachpage. Page 4 Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Commonwealth ofMassachusetts File with: City Or Town Clerk or Election Commission Please print or type all information, except signatures Fill In dates: Month Date Year MonthReportingPeriodBeginningt20Z-012 -- Ending + Type of report: (Check one) 8th day preceding preliminary )4th day preceding election 30 day after election STEPW_ J L, ff_6yZ_ Full Name of Candidate (if applicable) Sir An Office Sought and District Residential Address Tel. No. (optional) RECEIVED Date _ ar 7 i 28 LERK year -end report dissolution CNtK1_tVP_;: TO <9uEkT S t 12 Committee Name Name of Committee Treasurer 3 v -, 1 cT A e Committee Mailing Address Tel. No. (optional) SUMMARY BALANCE INFORMATION: Line 1: Ending balance from previous report $ 0 Line 2: Total receipts this period (page 2, line 11) $ 25p -DO Line 3: Subtotal (line 1 plus line 2) $ _ ZS'O.0p Line 4: Total expenditures this period (page 3, line 14) $ x-23 .110 Line 5: Ending balance (line 3 minus line 4) $ Line 6: Total in -kind contributions this period (page 4) $_0 Line 7: Total (all) outstanding liabilities (page 4) $ 0 Line 8: Name of bank(s) used C.A%-Jc' 1-' coo SS C-J)lV . k Affidavit of Committee Treasurer: 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 allcampaignfinanceactivincludingallcontributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting periodandrepresentstheignfinanceactivityofallpersonsactingundertheauthorityoronbehalfofthiscommitteeinacordancewiththerequirementsofM.G.L. c. 55. Signed under the penalties of perjurv: I Treasurer's sige Cn ink) S t,2>— FOR CANDIDATE FILINGS ONLY,, - (CANDIDATE MUST SIGN RELOW1 Affidavit of Candidate: (check 1 box only) Candidate with Committee and no activity independent of the committee 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 allmpaignfinanceactivity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements ofM.G.L. c. 55. Iavenotreceivedanycontributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Candidate without Committee OR Candidate with independent activity filing 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 allcampaignfinanceactivity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting periodandrepresentsthecapaignfinanceactivityofallpersonsactingundertheauthorityoronbehalfofthiscommitteeinaccordancewiththerequirementsofM.G.L. c. 55. Signed under the penalties ofperjury: Candidate sig re (in ink) ate SCHEDULE A: RECEIPTS M.G.L. c. 55 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 ofall receipts, but need only itemize those receipts over $50. In addition, the occupation and employer must be reportedfor all persons who contribute $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 number on each page. Date Received Name and Residential Address alphabetical listing required) Amount Occupation & Employer for contributions of $200 or more) 3W/ L 57i!-pt" ' 4 NR4}A(\-,l T CN Z CIO V)q__ TA-r- 414 1 Z 7` . 443 Jog Line 9: Total receipts in excess of $50 (or listed above) Enter on 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. Line 10 should include only those receipts not itemized above. Page 2 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 keepdetailedaccountsandrecordsofallexpenditures, but need only itemize those over $50. Expenditures $50 and under may be addedtogether, from committee records, and reported online 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 alphabetical listing) Address Purpose of Expenditure Amount 3 ICU Ie t lR dK L C?1C 1 D 2l i0 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