HomeMy WebLinkAboutO Report (Fee - 2015)Form CPF M 102-0: Campaign Finance Report
Municipal Form
ofrice or Campaign and Political Finance
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City or Town of: 1 y C 117 I I S
Please print or type all information, except signatures.
ill in dates: Month Day
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Year Month
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Year
Z/ ( Zeporting Period Beginning
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Type of Report: (Check One)
O 8th day preceding U --8th day preceding election CD 30th day following election 20th day of January
preliminary/primary (Town or Special) (Year -End Report)
Pursuant to M.G.L., Chapter 55:
I. I certify that I am a candidate for or hold Municipal Office.
2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this
reporting period, and do not have a campaign fund in existence.
3. I certify that I do not have a political committee.
DATE 1. SIGNATURE II. RESIDENTIAL ADDRESS III. OFFICE SOUGHT
Sign under the penalties of perjury Street and Number)
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Form CPF M 102-0: Campaign Finance Report
Municipal Form
Office ofCampaign and Political Finance
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of MuaICAYN1i / / n
City or Town of:
Please print or type all information, except signatures.
Fill in dates:Day Year Month y Yea`
Reporting Period Beginning
n
Z? //,Ending
Type of Report: (Check One)
8th day preceding 8th day preceding election /30th day following election 20th day of January
preliminary/primary (Town or Special) (Year -End Report) j
Pursuant to M.G.L., Chapter 55:
I. I certify that I am a candidate for or hold Municipal Office.
2. I certify that t have not received any contributions, made any expenditures, or incurred any obligations during this
reporting period, and do not have a campaign fund in existence.
3. I certify that I do not have a political committee.
DATE I. SIGNATURE
Signed under the penalties of perjury
1
1I. RESIDENTIAL ADDRES§7
Street and Number)
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111. OFFICE SOUGHT
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Form CPF M 9: Disclosure of Credit Card Activity
Office of Campaign and Political Finance
ofMases
File with: City or Town Cleric or Election Commission
Please print or type all information, except signatures.
Type of report: (Check one)
8th day preceding preliminary Usth day preceding election 30 days after election year-end Odissolution
Credit Card Statement Period Beginning / Ending /gq —
Name of Committee:
Name of Individual(s) Authorized to Use Credit Card:
Beginning Outstanding Balance
Itemize ALL charges of more than $50
Date Vendor & Address Authorized By Purpose
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N.B. A copy of the credit card
statement must be attached.
Signed under the penalties of perjury:
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1. Charges more than $50
2. + Charges $50 and under
3. + Interest charges this period
4. = Total charges this period
5. (-) Payments this period
6. Ending outstanding balance
Signed under the penalties of perjury:
Candidate Signature Date Treasurer Signature Date
NOTES:
1. A copy of the credit card statement(s) must be attached to this form.
2. The balance outstanding should agree with the ending balance on the most recent credit card statementline6).
3. This form should be complete as of the most recent credit card statement received .
When to rile credit card reports:
This form must be filed with the campaign finance reports 8 days before the primary, 8 days before theelection, 30 days after an election and the 20th of January year-end report.
CPF M9 11/95
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