HomeMy WebLinkAbout2017 Statement of Organization Form CPF M101: STATEMENT OF ORGANIZATION
E. '. , CANDIDATE'S COMMITTEE
MUNICIPAL FORM
Commonwealth Office of Campaign and Political Finance
of Massachusetts
File with: City/Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amended,of the organization of a
candidates committee as follows:
CANDIDATE: Full Name: I (.7-(3- I tJ S
Residential Address: J Cl 1/2.. M(LL6 O`! R.D
City/State/Zip: > -t Llu<E-T /4A 02 S 5 + '' Z C
E-Mail Address: • ((4-( N S • l�E�e ( �( lam. co I� Phone#: 7 ci;
Party Affiliation: 3 applicable)
OFFICE SOUGHT/PURPOSE:
-
Title: --
O esc 1) 0t- S�L,Cc-T/-tc
District: `fir
COMMITTEE: Name of Committee: CO Km(Tre E -co k-t& - --(hi s
(The name of the committee must include the candidate's last name)
Committee Mailing Address: 3 Ct % (-2._ A -.LA2)(2�`� 1-2...D
City/State/Zip: {� \�'M C C " eA 4 O-2.-S J y Phone# 7 7'( 23 (O 01 Zz.
OFFICERS:
Chairman: o)F E VA(<1 q /,/ Treasurer*: AMY 2 (_E N S I —i
Residential Address: 5/t (IA;a„ Residential Address: 5 mA-D I S o r` c_-r
City/State/Zip: Al f/4.'1 Jctul_4_ �✓1 t CZ-I City/State/Zip: 1%)A�'r� (��� MA o2-5 5L/
Phone#: p �3 Z °l Phone#:ZGo 9"1 y50 By Email: Ainv ZI G-i' K I�J o44.4%.co M
*A public employee may not serve as treasurer,of any political committee(see reverse).
Other Officer/Title: Other Officer/Title:
Residential Address: Residential Address:
City/State/Zip: City/State/Zip:
Phone#: Phone#:
(Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,if any.)
I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her
behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY:
&imam/ Date: 1 3 it 7.
Candi' gnatu7911174LMO■
I hereby accept the office of Treasurer of the above-named committee.I affirm that I not a publi ployee as defined by M.G.L.c.55,s. 13.1 understand
that: I)I am subject to certain duties and liabilities under M.G.L.c.55, including the t el fili • t'campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of six years from the date of the relevant election;2)if alter my acceptance of this office I become an
appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED UNDER THE PENALTIES OF PERJURY: — Date: S
Treas er s sig .r.•ure
I hereby accept the office of Chairman of the above-named commi e.
SIGNED UNDER THE PENALTIES OF PERJURY:
Chai an's signature Date:
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