HomeMy WebLinkAbout2018 30 days afterForm CPF M 102: Campaign Finance Report
Municipal Form
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Office of Campaign and Political Finance
Commonwealth
of Moefnchute"i
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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
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"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�
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GS
3
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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
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* 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