HomeMy WebLinkAbout2017 8th day Preceding Form CPF M 102: Campaign Finance Report TOWN
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File with:
City or Town Clerk or Election Commission
Please pnnt or type all information, except signatures.
Fill in dates: Monte Date Year Month Dote
Year
Ending
Reporting Period Beginning En
Type of report: (Check one)
08th day preceding preliminary lsJ'8th day preceding election ❑30 day after election ❑year-eend report ❑dissolution
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Full Name of Candidate(if applicable) Committee Name
Office Sought and District Name of Committee Treasurer
6-p 10/Ae01f1et-Aee
Residential Address Committee Mailing Address
id '? 44C Oil et—Ayev j
Tel. No. (optional) Tel. No. (optional)
SUMMARY BALANCE INFORMATION: , l
Line 1: Ending balance from previous report S v
Line 2: Total receipts this period (page 2, line 11) $ 0 ;'ram W
Line 3: Subtotal (line 1 plus line 2) $ is V
Line 4: Total expenditures this period (page 3, line 14) $ 0
Line 5: Ending balance (line 3 minus line 4) $
Line 6: Total in-kind contributions this period (page 4) $
Line 7: Total (all) outstanding liabilities (page 4) S
Line 8: Name of bank(s) used J
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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 penod 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:
Date
Treasurer's signature(in ink)
FOR CANDIDATE FILINGS ONLY: (CANDIDATE MUST SIGN BELOW)
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Affidavit of Candidate: (check only)
•
1 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 dance with the requirements of M.G.L.c 55. I have not received and
ontributions,incurred any liabilities nor made any expenditures on my behalf during this reporting od.
1 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 undethe rauthority der the penalties his perjury:
in accordance with the requirements of M.G.L.c.55
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-- Date
Candidat signature in inl.)
SCHEDULE B: EXPENDITURES
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 Address Purpose of Expenditure Amount
(alphabetical listing)
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Line 12: Expenditures over$50
Line 13: Expenditures $50 and unders 1
Enter on page 1, line 4 Line 14:TOTAL EXPENDITURES I6- ( 14-/
*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
Form CPF M 102: Campaign Finance Report
' Municipal Form
1' 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: 3/01/2017 Ending Date: 4/03/2017 0 +1 z
Up
Z
Type of Report: (Check one) Z—4
❑ 8th day preceding preliminary ❑X 8th day preceding election ❑ 30 day after election ❑ year-end report ( dissolytt�'iir
r
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Rita Higgins Committee to Elect Rita Higgins c'J -t
Candidate Full Name(if applicable) Committee Name ;�
Board of Selectmen, Nantucket, MA Amy Zielinski (A)
Office Sought and District Name of Committee Treasurer
39 1/2 Millbrook Rd, Nantucket, MA 02554 39 1/2 Millbrook Rd Nantucket MA 02554
Residential Address Committee Mailing Address
E-mail: higgins.req@gmail.com E-mail: amy.zielinski@gmail.com
Phone#(optional): Phone#(optional):
SUMMARY BALANCE INFORMATION:
Line 1: Ending Balance from previous report 0
Line 2: Total receipts this period(page 3, line 11) 4528
Line 3: Subtotal(line 1 plus line 2) 4528
Line 4: Total expenditures this period(page 5, line 14) 2707.98
Line 5: Ending Balance(line 3 minus line 4) 1820.02
Line 6: Total in-kind contributions this period(page 6) 0
Line 7: Total(all)outstanding liabilities(page 7) 1840
Line 8: Name of bank(s)used: Nantucket Bank
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,receip bs e. res,disbursements,in-kind contributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the .' bEhalf oethis committee in accordance with the requirements of M.G.L.c.55.
Signed under the penalties of perjury: MAIM (Treasurer's signature) Date: 4/03/2017
FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(check 1 box only)
Candidate with Committee and no activity independent of the committee
l 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 actin. i+ . ty Or on behalf of this committee in accordance with the requirements of M.G.L.c.55.
1 �,� Date: 4/03/2017
Signed under the penalties of perjury: �_ -�im (Candidate's signature)
SCHEDULE A: RECEIPTS
M.G.G. 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)
Atherton, D. Anne
4/2/17 48 Squam Rd 100
Nantucket, MA 02554
Berman, Susan
4/2/17 28 Miacomet Rd, Nantucket, MA 02554 100
Buccino, Elizabeth
4/1/17 38 Friendship Lane 50
Nantucket, MA 02554
Bund, Barbara
3/15/17 12 Equator Drive 100
Nantucket, MA 02554
Daily, Sunny
4/1/17 1 Whitetail Circle 50
Nantucket, MA 02554
Dey, Penny
3/6/17 17 Warren St 250
Nantucket, MA
Fee, Matt
3/13/17 50 Cliff Rd 100
Nantucket, MA 02554
Gould,Gabrielle
3/26/17 15 Margaret's Way 50
Nantucket, MA 02554
Grenier,Tamara self-employed
3/18/17 64 S Shore Rd 500
Nantucket, MA 02554
Higgins, Dean retired
3/28/17 15 Saratoga Circle 400
Saratoga Springs, NY 12866
Higgins, Rita - Candidate Loan self-employed
3/1/17 39 1/2 Millbrok Rd 1840
Nantucket, MA 02554
Kaizer, Katie
3/26/17 8 N Beach St 50
Nantucket, MA 02554
Line 9: Total Receipts over$50(or listed above) I
Line 10: Total Receipts $50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD I 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 A: RECEIPTS (continued)
Name and Residential Address Occupation& Employer
Date Received (alphabetical listing required) Amount (for contributions of$200 or more)
Klepetar,Colin
3/16/17 58 Newton Avenue 100
Saratoga Springs, NY 12866
LaHiff, Patricia
3/18/17 27 Evergreen Way 100
Nantucket, MA 02554
McIver, Scott
3/31/17 22 Miacomet Rd 50
Nantucket, MA 02554
Neil Paterson
3/31/17 11 Burnt Swamp Lane 50
Nantucket, MA 02554
Werner, Karen
3/31/17 250 Milestone Rd 350
Nantucket, MA 02554
Zielinski,Amy
3/1/17 5 Madison Court 100
Nantucket, MA 02554
Line 9: Total Receipts over$50(or listed above) 43401
Line 10: Total Receipts$50 and under* (not listed above) I 1881
Line 11: TOTAL RECEIPTS IN THE PERIOD 45281 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
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
Graphicsland 8061 W 186th St Bumper Stickers
3/24/17 W Tinley, IL 60487 128.03
I&M 1 Old South Rd Inky Ads
3/28/17 Nantucket, MA 02554 778.98
Island Lumber 1 Polpis Rd Extra Stakes
4/1/17 Nantucket, MA 02554 66
Marine Home Center 134 Orange St Sign Making Materials
3/26/17 Nantucket, MA 02554 129.33
Moo 14 Blackstone Valley Place Business Cards
3/3/17 Lincoln, RI 02865 247.50
Prairie Moon Nursery 32115 Prairie Lane Seeds
3/2/17 Winona, MN 55897 440.36
Pure Labels 2010 W Fulton Street Seed Packet Labels
3/6/17 Suite F-239 291.66
Chicago, IL 60612
Seed Needs PO Box 40 Seed Packets
3/6/17 New Baltimore, MI 48047 110
Shangri-La 149 Orange St Seed Packet Party Food
3/9/17 Nantucket, MA 02554 136
Line 12: Total Expenditures over$50(or listed above) I 2327.86
Line 13:Total Expenditures$50 and under* (not listed above) I 380.12
Enter on page 1,line 4--) Line 14: TOTAL EXPENDITURES IN THE PERIOD
I 2707.98
* If you have itemized expenditures of$50 and under,include them in line 12. Line 13 should include only those expenditures not itemized
Page 4
above.
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) I
Line 16: In-Kind Contributions$50&under(not listed above)I
Enter on page 1,line 6-* Line 17: TOTAL IN-KIND CONTRIBUTIONS I
* 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
Rita Higgins 39 1/2 Millbrook Rd Candidate Loan
3/1/17 Nantucket, MA 02554 1840
Enter on page 1,line 7-, Line 18: TOTAL OUTSTANDING LIABILITIES(ALL) 11840
Page 7