HomeMy WebLinkAbout2019-Dissolution Form CPF M 102: Campaign Finance Report
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Municipal Form
Office of Campaign and Political I?I 8 37
Commonwealth
of Massachusetts
File with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: Beginning Date: Ending Date: i 2 (tic. I I .
Type of Report: (Check one)
❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year-end report dissolution
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Candidate Full Name(if applicable) Committee Name
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Office Sought and District Name of-committee Tr urer
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Residential Address , ,/}77-7-7/6-‘7,' Committee Mailing
ommitteeMailing Addr
E-mail: b rr E-mail:
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Phone#(optional):C 30gas-
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SUMMARY BALANCE INFORMATION:
Line l: Ending Balance from previous report 550
Line 2: Total receipts this period(page 3,line 11)
Line 3: Subtotal(line 1 plus line 2) SCS
Line 4: Total expenditures this period(page 5,line 14) . $ t , o
Line 5: Ending Balance(line 3 minus line 4)
Line 6: Total in-kind contributions this period(page 6)
Line 7: Total(all)outstanding liabilities(page 7)
Line 8: Name of bank(s)used: � CU d,
Affidavit of Committee Treasurer:
I certify that I have examined this report including attached schedules and it is,to the a= .f my knowledge and belief,a true and complete statement of all campaign finance
activity,including all contributions,loans,receipts,expenditures,disbursements,i • . ontributions and liabilities for this reporting period and represents the campaign
finance activity of all persons acting under the authori half of this co, in accordance with the requirements of M.G.L.c.55.
Signed under the penalties of perjury: (Treasurer's signature) Date: OIL— 4,
FOR CANDIDATE FILINGS ONLY: Affidav andi'ate:(check 1 box only)
Candidate with Committee
ni I certify that I have examined this report including attached schedules and it s,to the best of my knowledge and belief,a true and complete statement of all campaign finance
,J activity,of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L.c.55. 1 have not received any contributions,
incurred any liabilities nor made any expenditures on my behalf during this reporting period that are not otherwise disclosed in this report.
Candidate without Committee
in 1 certify that 1 have examined this report including attached schedules and it is,to the hest of m knowledge and belief,a true and complete statement of all campaign
finance activity,including contributions,loans,receipts,expend'. es,. •, ements,in-kind con a . ions and liabilities for this reporting period and represents the
campaign finance activity of all persons der the autho 41 or. a.' alf of this candidate in ac .rdance with the requirements of M.G.L.c.55.
/ (Candidate's signature) Date: a a
Signed under the penalties of perjury: :o s.?_