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OCPF 2016 30 Days after Form CPF M 102: Campaign Finance Report K !f 5, Municipal Form Office of Campaign and Political Finance Commonwealth ` of Massachusetts File with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: 2,3, / , ,0/4, Ending Date: - 0/(o Type of Report: (Check one) ❑ 8th day preceding preliminary ❑ 8th day preceding election [2'30 day after election ❑ year-end report ❑ dissolution ,1, S /2 / / J, A- Candidate Full Name(if applicable) Committee Name /L./Ce /.5 'o-' .(e /11a'L M y/e_eil Office Sou ht and District Name of Committee Treasurer ln/rt e:) 17rl�7,I � IN /"�?-�i�i/c�f /q4 p /). 2 q 1 5 /14-/ a ti Li'f Mei G 1-111 Residential Address Committee Mailing Address E-mail. S/ji/ r,�t, /r�c'_ sI ? �49/ (0(0-44 E-mail: Phone#(optional): Phone#(optional): SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report /6 79 01 Line 2: Total receipts this period (page 3, line 11) /p p o, OD Line 3: Subtotal (line 1 plus line 2) (/ -2'1. 19' Line 4: Total expenditures this period (page 5, line 14) (.0 6) Line 5: Ending Balance(line 3 minus line 4) 7 Au_al Line 6: Total in-kind contributions this period (page 6) --0 -- Line 7: Total (all) outstanding liabilities (page 7) 7 A ) •) Line 8: Name of bank(s) used: /1/4_/4,/ 46er /3 a-,/6. 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 all campaign finance activity,including all contributions,loans,receipts,expenditures,disb sements,in-kind contributions and liabilities for this reporting period and represents the camaaien finance activity of all persons acting under the authority o on be aie this mitte/s acco :.nce with the requirements of M.G.L.c.55. /!// / (Treasurer's signature) Date: 3 - Signed under the penalties of perjury: _ , �� � ( g ) FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(c ec,'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 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 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 all campaign r--1 finance activity,including contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represen'':;the 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. / Date: '/O ' ' Signed under the penalties of perjury: (Candidate's signature) 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. In 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.) Name and Residential Address Occupation&Employer Date Received (alphabetical listing required) Amount (for contributions of$200 or more) i IG v',1Vt (( i1c dctt ,� - lax: cJ(2 r +1 6 I • Line 9: Total Receipts over$50(or listed above) 1.GV VO Line 10: Total Receipts$50 and under* (not listed above) Line 11: TOTAL RECEIPTS IN THE PERIOD � OO'',th/ F- 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 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 committee name and a page number on each page.) To Whom Paid Date Paid (alphabetical listing) Address Purpose of Expenditure Amount J N1 U 61, a �E> h \ ci di/l,--A 1/yf G q i yI, q J � L �C?n1c 804k-' r.'cPsiln� 5 �ti� �' he ut5 /011 flit M L-f q,Js- //,, /�(/, /�/' .Y iSa°t. k s tys __)c ys 4/,, 4/./Ar /; /61(1!wI`1 3 tiet�l `�t'l.CL ,O.J ./.`✓`l• 77 • Line 12: Total Expenditures over$50(or listed above) . (II, Line 13: Total Expenditures$50 and under* (not listed above) I . -- Enter on page 1,line 4-) Line 14: TOTAL EXPENDITURES IN THE PERIOD ( i";1- *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 4 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 3I 1\tlo Vi s-k, fr.%Act ,4 ,t�- rn3#� �'<2.r t�� 1 ..),Irs 78 1? toy `i33`� 3I' I11b S.Js c, - C. ;� Cd , ''�et 5' .7.l :,.k .�tY S e-- h Z . o it lit, Attt,, LA.,;, ,L,, . i- Mi ,Aziv>'-A s,-, 136 Enter on page 1,line 7 - Line 18: TOTAL OUTSTANDING LIABILITIES (ALL) 1 ).3 _)j Page 7