HomeMy WebLinkAboutStatement of OrganizationM,\ Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
MUNICIPAL FORM {' :
Commonwealth Office of Campaign and Political Finance 2019 FEB 19 AM 8: 41
of Massachusetts
File with: City / Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws, Chapter 55, as amended, of the organization of a
candidate's committee as follows:
TE: Full Name:
Residential Address: 2 I A- 71ar K C I`rcI
City / State / Zip: N O_C0-y Cy -e_ -1- &A A- D 2 s- S
E -Mail Address: Wex , fC MLI `' A A Phone #: S 33,9 q S U
Party Affiliation: n? Or Y, (Ifapplicable)
OFFICE SOUGHT/PURPOSE:
Title: bacte. " m LVL ---
District:
efZ--
District:
COMMITTEE: Name of Committee: &Vwm1 Lt to ,u,4 YIS 1P 1',PVlrayl-i-P '
The name of the committee must include the candidate's last name)
Committee Mailing Address: .p d 2) (A 5ILD
City / State / Zip: a +A J<,J +0 zPhone #: `r) a - 21'5_ Q O U7 -
OFFICERS:
Chair: g, r% L i 2 < Treasurer*: M ea han i t ct U a, v
Residential Address: 1 S 0 3 (, Residential Address: I s
City / State / Zip: p, (A V't.. A- f City / State / Zip: N CLVI f ,55
Phone #: j I
Phone #: 3 irK Ipfyy,PXc, Q2, +—
A ublic employeeee ma not serve as treasurer of anlitiea committee see reverse .
Other Officer/Title: Other Officer/Title:
Residential Address: Residential Address:
City / State / Zip: City / State / Zip:
Phone #: Phone #:
Complete and attach a Form CPF M A 1 U 1, a necessary, with other officers and rmance connnnico, n miy.y
I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her
behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY:
Date: 2 f s ( 9
Candidate's signature
I hereby accept the office of Treasurer of the above-named committee. I affirm that I am not a public employee as defined by M.G.L. c. 55, s. 13. I understand
that: 1) I am subject to certain duties and liabilities under M.G.L. c. 55, including the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of six years from the date of the relevant election; 2) if after my acceptance of this office I become an
appointed public employee, I must resign this position and notify OCPF of my resignation; and 3) a candidate may not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED UNDER THE PENALTIES OF PERJURY: Date:
Treasurer's signature -
I hereby accept the office of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
Chair ignature
Date: L
COI