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OCPF 2016 8 Days Before7 gy Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance Fill in Reporting Period dates: Beginning Date: Zan u A, 2o, a ft Ending Date: Ma",A ld°, a 0 1 to Type of Report: (Check one) U� ITn day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year -end report ❑ dissolution I- -James Fl. K_ ii Candidate Full Name (if applicable) B©ar01 o4i N14A 1W G ke+ Office Sou ht and District I � / _/ S h m am o O n0l 1061() , Reside -nJt al Address E -mail .S�J�/!)/'Y10)� 0Y7 GX �Qt%A Phone # (optional): Committee N e r� �y Name of Committee/ TTr asurer / Y ,,iry I Nekz� IYM Committee Mailing Address E -mail: Phone # (optional): SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period (page 3, line 1 1) Line 3: Subtotal (line 1 plus line 2) Line 4: Total expenditures this period (page 5, line 14) Line 5: Ending Balance (line 3 minus line 4) 100 .00 -4 _2, 000. 00 q9 -7 !. 0/ Line 6: Total in -kind contributions this period (page 6) o Line 7: Total (all) outstanding liabilities (page 7) 9 y0 „ Line 8: Name of bank(s) used: pry -z” ke�&- "k- , 1,14"O'sa 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, expenditures, disbursements in -kind contributions and liabilities for this reporting period and represents the camoaian finance activity of all persons acting under the authority or on behalf of this nn ittee in accordance with the requirements of M.G.L. c. 55. signature) Date: C Signed under the penalties of perjury: �i!� ( Treasurer's g nature ) 7 / — 4./-- : Affidavit of CandiS(ty'f (check 1 box only) Candidate with Committee and no activity independent of thk/ommittee 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, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. 1 have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. C tdidate without Committee OR Candidate with independent activity filing separate report 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 acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L c. 55. c �. / Date:dlwl (Candidate's signature) ed under the penalties of perjury: 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.) Date Received flog, Name and Residential Address Occupation & Employer (alphabetical listing required) Amount (for contributions of $200 or more) Sa,.'e s 9 8 Shim "V Poled Roao/ .do•��u�k -c+' MN v 21 s sY � /,ODO. od Jdy�� s a Pw,d o/ -5'A; rr.n oa ,/✓o.��cl�kef �'iiF oassy /, age. 00 si-d 4u h 044 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 IIa, 000. oo 0, 00 j W0. 00 ll+-- Enter on page], 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 A: RECEIPTS (continued) Date Received Name and Residential Address (alphabetical listing required) Amount Occupation & Employer (for contributions of $200 or more) Line 9: Total Receipts over $50 (or listed above) E— 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 3 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 3 i8 a01 nrw1*07. and /y;vrov P.O. Bay I19� Adve;, -t i sib 3Qa, 99 i✓o,7 tae ket /V 0--63Y ,.1 Line 12: Total Expenditures over $50 (or listed above) Sao • 99 Line 13: Total Expenditures $50 and under* (not listed above) — o' Enter on page 1, line 4 Line 14: TOTAL EXPENDITURES IN THE PERIOD * 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 B: EXPENDITURES (continued) Date Paid To Whom Paid (alphabetical listing) Address Purpose of Expenditure Amount Line 12: Expenditures over $50 (or listed above) Line 13: Expenditures $50 and under* (not listed above) Enter on page 1, line 4 --.> Line 14: TOTAL EXPENDITURES IN THE PERIOD C� * 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 Enter on page 1, line 6 Line 15: In -Kind Contributions over $50 (or listed above) Line 16: In -Kind Contributions $50 & under (not listed above) 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 SCHEDULED: 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 / ?01b Vi ska P..;� a� S �✓ rra.� s�Y'��r Ca�.�r� n s►�ns ���o, yS oa Ysl � �J ill 1C�C ICJ Enter on _<<. line d4G Y5 J Page 7