HomeMy WebLinkAboutStatement of Organizaation Form CPF M101: STATEMENT OF ORGANIZATION
r. '; c/ CANDIDATE'S COMMITTEE
` MUNICIPAL FORM
I
Commonwealth Office of Campaign and Political Finance
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: �/JCe CANDIDATE: Full Name: _ .40 v / /" / 4_C ,g Q E
Residential Address: t jeraN?0y? 69 c' ,�y/,/✓� i • �i_
City/State/Zip: A ',A 4 e /f r A (2? 5
E-Mail Address: r - 7, £ Phone# Q ' d Q%Va
Party /4,S�4-T6, \ (If applicable)
Affiliation: /�/ LJ
OFFICE SOUGHT/PURPOSE: ��/
Title: /�l Ili ,e' — R.A414 4/4 (1•94' ,6
District: /V/Q/y rGf CA' J
COMMITTEE: Name of Committee: /Ve e‘clJc 6A Ora41,v' i) 15
(The name/the committee must include95 candidate's last name)
Committee Mailing Address: ! � i`f ah e /1 0 Ail
City/State/Zip: !/ V,?-i/r h I(E/T-- /Cf4 cc -K-S`5( Phone#:SD 2 2` 0 070
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OFFICERS: /�' [�
Chairman: ,4�,oex!G",�? HS di_$/,Ln GTreasurer*: /0 *( �'- i • Ar!
Residential Address: � D (l� E" Residential Address: L"' ' (,a VI r("( .1 V 6
City/State/Zip: Ln City/State/Zip: Ta N'tUGfCer L ban*
.
Phone#: t 1 c... t Phone# p e.2g 2.170D Email:,sit M� ��y 1 Gmh"..cowl
1
7
,a.11.1 lc SA public employee may not serve as treasurer of any political committee(see reversel.
Other Offieri: a" Other Officer/fitle: press mtp..►1'{'f p MR.:U :Croak Oftitta LIPQ
Residentia)"/{d 2s: to Residential Address: I r y2`yS�i L%'i skean-
City .ii7 ES
City/State/Zip: "TNR'v t ✓• MA -
City/State�li� W
L- Del. 951' 4142
.< - Phone#:
Phone#: -7.`-� m
t e (Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,if any.)
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 d 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: >ifilfrif,e/ , L/vw frA - Date: Z.L l�
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. p�
SIGNED UNDER THE PENALTIES OF PERJURY: OilDate. &1*pg.
Treas signature
I hereby accept the office of Chairman of the above-named committee. C
SIGNED UNDER THE PENALTIES OF PERJURY: //f Q/
c` Date: z-/d/2e4
• Chairman's signature