HomeMy WebLinkAbout2017 39 Day After election SCHEDULE A: RECEIPTS (continued)
Name and Residential Address Occupation & Employer
Date Received (alphabetical listing required) Amount (for contributions of$200 or more)
Line 9: Total Receipts over$50 (or listed above)
Line 10: Total Receipts$50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD 450 4- Enter on page 1,line 2
* 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 3
SCHEDULE B: EXPENDITURES (continued)
To Whom Paid
Date Paid (alphabetical listing) Address Purpose of Expenditure Amount
Line 12: Expenditures over$50(or listed above) I
Line 13: Expenditures$50 and under* (not listed above)
Enter on page 1,line 4—, Line 14: TOTAL EXPENDITURES IN THE PERIOD
I 589.77
* 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 5
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 on page 1.
Date Received From Whom Received* Residential Address Description of Contribution Value
Line 15: In-Kind Contributions over$50 (or listed above)
Line 16: In-Kind Contributions $50 & under(not listed above)
Enter on page 1,line 6 —> Line 17: TOTAL IN-KIND CONTRIBUTIONS 0
* 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. Page 6
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: TOTAL OUTSTANDING LIABILITIES(ALL) 0
Page 7
tl
Commonwealth
of Massachusetts
Form CPF M 102: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
(Fill in Reporting Period dates: Beginning Date: 4/4/2017 Ending Date: May 9, 2017
Type of Report: (Check one) z � Z
❑ 8th day preceding preliminary ❑ 8th day preceding election ❑X 30 day after election ❑ year-end report dissAi'
Kristina Jelleme
Candidate Full Name (if applicable)
Land Bank Commission, Nantucket
Office Sought and District
9 Kelley Road, Nantucket, MA 02554
Residential Address
E-mail: kjelleme@gmail.com
Phone # (optional): (508) 228-8510
r, -;r,
Committee to Elect Kristina Jelleme (n
Committee Name
Penny Dey t
Name of Committee Treasurer
17 Warren Street, Nantucket, MA 02554
Committee Mailing Address
E-mail: penny@nantucketrealestate.com
Phone # (optional): (508) 221-0801
Affidavit of Committee Treasurer:
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 statement of all campaign finance
activity, including all contributions, loans, receipts,aioron
ndures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the auth behalf of thi committee in accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury: Date: May 9, 2017(Treasurer's signature)
FOR CANDIDATE FILINGS ON .Y:ffidavit of Can te: (chec 1 x only)
Candidate with Committee and no activity independent of the committee
RI 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 under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions,
incurred any liabilities nor made any expenditures on my behalf during this reporting period.
Candidate without Committee 9$ Candidate with independent activity filing 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 statement of all campaign
finance activity, including contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the
campaign finance activity of all persons a ting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55.
SSigned under the penalties of perjury: A A AN (Candidate's signature) Date:
SUMMARY BALANCE INFORMATION:
Line 1:
Ending Balance from previous report
586.37
Line 2:
Total receipts this period (page 3, line 11)
450
Line 3:
Subtotal (line 1 plus line 2)
1,036.37
Line 4:
Total expenditures this period (page 5, line 14)
589.77
Line 5:
Ending Balance (line 3 minus line 4) F
446.6
Line 6:
Total in-kind contributions this period (page 6)
o
Line 7:
Total (all) outstanding liabilities (page 7)
o
Line 8:
Name of bank(s) used: I Cape Cod Five Bank
Affidavit of Committee Treasurer:
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 statement of all campaign finance
activity, including all contributions, loans, receipts,aioron
ndures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the auth behalf of thi committee in accordance with the requirements of M.G.L. c. 55.
Signed under the penalties of perjury: Date: May 9, 2017(Treasurer's signature)
FOR CANDIDATE FILINGS ON .Y:ffidavit of Can te: (chec 1 x only)
Candidate with Committee and no activity independent of the committee
RI 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 under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions,
incurred any liabilities nor made any expenditures on my behalf during this reporting period.
Candidate without Committee 9$ Candidate with independent activity filing 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 statement of all campaign
finance activity, including contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the
campaign finance activity of all persons a ting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55.
SSigned under the penalties of perjury: A A AN (Candidate's signature) Date:
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 of all receipts, but need only itemize those receipts over $50. /n addition, the
occupation and employer must be reported for all persons who contribute $200 or more in a calendar year.
(A "Schedule A: Receipts" attachment is available to complete, print and attach to this report, if additional pages are required to
report all receipts. Please include your committee name and a page number on each page.)
Date Received
Apr 5, 2017
Apr 5, 2017
Apr 5, 2017
Name and Residential Address
(alphabetical listing required)
Dan Balling
66 Fairgrounds Road
Nantucket, MA 02554
Herbert W. Goodall
109 Tealnest Court
Ponte Verde Beach, FL 32082
Michael Holdgate
6 Vesper Lane
Nantucket, MA 02554
Amount
100
100
100
Occupation & Employer
(for contributions of $200 or more)
Apr 5, 2017
Karen Werner
8 Hoicks Hollow Road
Nantucket, MA 02554
150
Line 9: Total Receipts over $50 (or listed above)
450
Enter on page 1, line 2
Line 10: Total Receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD
450
* 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 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.
(A "Schedule B: Expenditures" attachment is available to complete, print and attach to this report, if additional pages are required to
report all expenditures. Please include your committPP names o"A
Date Paid
To Whom Paid
(alphabetical listing)
------ •-_-........... }.wsa ..u.uvc.
Address
"u encu page.)
Purpose of Expenditure
Print Advertising
Amount
353.48
Apr 12, 2017
Inquirer & Mirror
P.O. Box 1198
Nantucket, MA 02554
Apr 12, 2017
Poet's Corner Press, LLC
P.O. Box 2152
Nantucket, MA 02584
Print Advertising
236.29
Line 12: Total Expenditures over
$50 (or listed above)
589.77
Line 13: Total Expenditures $50
and under* (not listed above)
Enter on page 1, line 4
Line 14: TOTAL EXPENDITURES
IN THE PERIOD
589.77
-- -•- ., F-1u.Lu,v3 vi n -)v adu under, mciude them in line 12. Line 13 should include only those expenditures not itemized
above.
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