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2018 30 days afterForm CPF M 102: Campaign Finance Report Municipal Form lug Office of Campaign and Political Finance Commonwealth of Moefnchute"i O File with: m 0 :j;' City or Town Clerk or Election Commission Please print or type all information, except signatures. -� Fill In dates: Month Date Year Month Date ear Reporting Period Beginning_q(PRL 2o(V Ending r Type of report: (Check one)_ El8th day preceding preliminary ❑ 8th day preceding election )00 day after election El year-end report ❑dissntion l L "D 1% F, t1i i lL( 04Wts Full Name of Candidate if ap licable) Office Sought and District I (ane Residential AddrVe/s'ss Tel. No. (optional) CQ1rmknJ: � ag�!C- l 1AAM W12,r ( AfAS Commi ee Name b k P'Al ! O' t G-16 T Name Committee Treasurer mi Mai 'n dres� V Tel. No. (optional) SUMMARY BALANCE INFORMATION Line 1: Ending balance from previous report Line 2: Total receipts this period (page 2, line 11) Line 3: Subtotal (line 1 plus line 2) Line 4: Total expenditures this period (page 3, line 14) Line 5: Ending balance (line 3 minus line 4) $ pros , ILi q $/,�7 $ _3 ;30r 2-7 Line 6: Total in-kind contributions this period (page 4) $ Line 7: Total (all) outstanding liabilities (page 4) $ Line 8: Name of bank(s) used C t2lC 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, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaig fi nce activity of all persons acting under the authority or on behalf of this committee in accordance wit the requirements of M. Signed under the penalties of perjury: P1 o l Treasu s signature (in i k) Date FOR CANDIDATE FILINGS ONLY: (CANDIDATE MUST SIGN BELOW) Affidavit of Candidate: (check 1 box only) ❑ Candidate with Committee and no activity independent of the committee 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, 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 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. Signed under the penalties of perjury: Candidate signature (in ink) Date SCHEDULE A: RECEIPTS M.G.L. c. 5J 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 occupati n and employer must be reported for 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 one ch page. Date Received Name and Residential Address _'V (alphabeticaa-li ti'g required) Amount Occupation & Employer Idfor contribu}tions of $200 or more) GO-TGf6-G� � r� - GS 3 Ga�►� I f Line 9:. otal receipts in excess of $50 (or listed above) 3G Enter on page 1, line 2 Line 10: otal 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 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. 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 P0 lt'o Enter on page 1, line 4 Line 12: Expenditures over $50 87 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 SCHEDULE C: "IN-KIND" CONTRIBUTIONS Please itemi a contributors who have made in-kind contributions of more than $50. In-kind contributions $50 and under may be added together fro the committee's records and included in line 16. Date Received From Whom Received* Residential Address Description of Contribution Value " If an in-kind address of the employer. M.G.L. c. SS those liabilities Line 15: In-kind over $50 Line 16: In-kind $50 and under Enter on page 1, line 6 Line 17: Total In-kind contribution is received from a person who contributes more than $50 in a calendar year, you must report the name an( contributor; in addition, if the contribution is $200 or more, you must also report the contributor's occupation an( SCHEDULE D: LIABILITIES requires committees to report .ALL liabilities which have been reported previously and are still outstanding, as well a incurred during this reporting period. Date Incurred To Whom Due Address Purpose Amount Enter on page 1, line 7 Line 18: OUTSTANDING LIABILITIES (ALL) This page ma3 be on each page. copied if additional pages are required to report all activity. Please include your committee name and a page number Page 4