HomeMy WebLinkAbout2019- 8 Days PriorForm CPF 111: REPORT OF ASSOCIATION OR OTHER GROUP
MAKING CONTRIBUTIONS TO OR EXPENDITURES ON BEHALF
OF CANDIDATES, PACS OR PARTY COMMITTEES
Commonwealth Office of Campaign and Political Finance
of Massachusetts
::or State or Count} Activity:
Pile with Director
O7ice of Campaign and Political Finance
One Ashburton Place, Room 411
Roston, MA 02108
Reporting Period: from: -Z r _�j to:
M/DD(YYYY) (MM/DD/YYYY)
For Municipal Activity:
File with City or Town Clerk
or Local Election Commission
Type of Report: ❑ 8th day preceding primary/preliminary [f8th day preceding election ❑ 30th day after election ❑ July 20th Janry`(Ith
On behal l' ol': ❑ State / County Candidates, PACs & Party Committees or afunicipal Candidates �„ t
Name ol'Association or Group:
�;' '4Wx4'y
Name & Tille of Principal Officers:
Mailing Address: -2 5' &.r6gz 5:�Z— City / State / Zip:
Pelermtnatton of incidental threshold: 1. Total gross revenues of previous calendar year:
$1030
2. 10% of line 1 or $15,000, whichever is less: $103
3. Total expenditures, donations to committees and liabilities incurred during calendar year: S ���
If line 3 exceeds line 2, reports are required for the stated calendar year.
POLITICAL RXPF.NDITURES AND CONTRIBUTIONS TO CANDIDATES/COMMITTEES (attach additional pages is necessary):
To Whom Paid Purpose
Date Paid (.Alphabetical listing) Address (Check box if Inkind Contribution)
IA,524,
.0 / U t� Ali /✓y✓czeY2
a r.� .sooty
Amount
or Value*
�000�
X000°D
�000�
Total expenditures/contributions on this report:
Total expenditures/contributions previously reported:®
Total expenditures/contributions to date:
*Inkind contributions (donations of goods or services) should be included in this list.
OVER
T,IABIT,ITTFS*:
Date
Incurred To Whom Due
Address
Purpose
Amount
00000
�000�
0000
X0000
00000
X0000
Total liabilities on this report:
Total liabilities previously reported and currently outstanding
Total outstanding liabilities":�
* A liability exists and must be reported if the association or group has received a good or service that it has not paid for, even if the association or group has
not received a bill or invoice. If the amount of the liability has not been determined or is in dispute, the liability should be estimated or reported as "to be
determined" or "in dispute."
** The final report must show zero liabilities.
1 certify that this report is a true statement of the amount or value of every gift, payment, expenditure or contribution or promise to give, pay, expend or
contribute, together with the date, purpose, and full name and address of the person to whom it was made.
Signed under the penalties of perjury:
tire of Officer
\N 110 NEEDS TO FILE THIS FORM?
Date: tel_,, Name:0 Dr
(MM/DD/YYYY)
Once an organization has made political contributions or expenditures or incurred liabilities to support candidates or political committees in excess of the
"incidental threshold" (i.e., $15,000 or 10% of such organization's gross revenues for the previous year, whichever is less), a duly qualified officer must file
this report. The report must disclose all contributions and expenditures made and liabilities incurred during the calendar year. The obligation to file a report
continues lin- each year thereafter until the year after a year in which the incidental threshold is not reached.
WIIERE SI IOULD THIS FORM BE FILED?
State and County Candidates or Committees: If contributions or expenditures are made to support or oppose state or county candidates or committees this
form should be tiled with OCPF.
Municipal Candidates or Committees: If contributions or expenditures are made to support or oppose municipal candidates or committees this form should
he filed with the city or town clerk or election commission.
WI IERE CAN I GET MORE INFORMATION?
You can view or download OCPF Interpretive Bulletin IB -88-01 from the Legal Resources section of OCPF's website at www.mass.gov/ocpf.
Call OCPF at (617) 979-8300 or (800) 462-OCPF.
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