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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��� ff . (Ii' ` CF2-S5 Email Address: (I U C �j1(n�� nCll Party Affiliation: (if applicable) ` Phone #: 3 2 cl~'�.._ OFFICE SOUGHT/PURPOSE: Title: -7 "'�-�' t �—IJ GO ; District: ,J �y'rur �i 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