HomeMy WebLinkAboutStatement of Organization�\ CPF ID #:
Form CPF 101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE
Commonwealth Office of Campaign and Political Finance
of Massachusetts
File with: Director
Office of Campaign and Political Finance
One Ashburton Place, Room 411, Boston, MA 02108
(For Off ice Use Only)
(617) 979-8300 / (800) 462-OCPF
ocpf@cpfstate.ma.us
www.mass.gov/ocpf
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:
CANDIDATE- First Name:
•
Middle Wtial:
Last Name: K—
2i V/VJ
Residential Address: � r V ! fC t
es_r /&-7
6n f e r S'
t
City/State/Zip: Nl"+,V UG���
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Email Address: (I U C �j1(n��
nCll
Party Affiliation: (if applicable) `
Phone #:
3 2 cl~'�.._
OFFICE SOUGHT/PURPOSE:
Title: -7
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GO ;
District: ,J �y'rur
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COMMITTEE: Name of committee: M rrl !?jVU:'_ Zb rte$ %i2 7L/U�Tf
(The name of the committee must include the candidate's last name)
Committee Mailing Address: PC) (gr -,Y gss
City 1 State /Zip: N �N % �C(s�L� lS �� s y Phone #: C5 ij 332 ms�4_
OFFICERS:
Chair: MM G Treasurer*: k4y
Residential Address: va< Residential Address:(5gL
City / State / Zip: AA City / State / Zip: N n171)4 -et TL 62—C.s y
Email: m L. rnq 16YI acyr Email:
Phone #: Z 1415 3-P3 Phone 252-3
* A public employee may not serve as treasurer of any political committee (see reverse).
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:
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: i' * „ n� Date: )12-'9111
Tr asurer's signature
I hereby accept the office of Chair of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
Date: �Z l
Chaies signature