HomeMy WebLinkAbout2019-Year End Form CPF M 102: Campaign Finance Report
-► , �` Municipal Form
1 a" Office of Campaign and Political Finance
Commonwealth
of Massachusetts File with: City or Town Clerk or Election Commission
Fill in Reporting Period dates: Beginning Date: Ending Date: ( ._ I -?•)1 ) I !'
Type of Report: (Check one)
❑ 8th day preceding preliminary El 8th day preceding election ❑ 30 day after election year-end report ❑ dissolution
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Candidate Full Name(if applicable) Committee N
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a,tn; a�n - 1�iot�-�ttelcc� / `( WA/�—� Office Sought and District / Nam
e of Committee Treasurer
So,n-�er 1--a..-^. /�€ ,cJ4 7 5 (T r /X1-'1;'�a ,
Residential Address ( y Committee Mailing Address C/
iI } E-mail: i<7 �^ //G'/vv(ll�� ei ./"'l/Y
Phone#(optional): ��or a aK- (s,4 4 7 Phone#(optional):
SUMMARY BALANCE INFORMATION:
Line 1: Ending Balance from previous report I 5 Q .
Line 2: Total receipts this period(page 3,line 11)
Line 3: Subtotal(line 1 plus line 2) 5—F G , 01
Line 4: Total expenditures this period(page 5,line 14) G
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:I CL‘ LI—
of Committee Treasurer: of
I certify that I have examined this report including attached schedules and it is,to the best of my knowledge and belief,a true and complerepresentstall campaign finance
activity,including all contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting periodand
ampaign
finance activity of all persons acting under the authority or behalf of this e in accordance with the requirements of M.G.L.c.55. Date (Li--p',--
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(Treasurer's signature)
Signed under the penalties of perjury:
FOR CANDIDATE FILINGS ONLY: Affidavit of Candida . check 1 box only)
s ,irndidate with Committee
certify that I have examined this report including attached •i- it es and it is,to the best of my knowledge and belief,a true and complete statement of all campaign finance
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. I 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
I certify that I have examined this report including attached schedules and it is,to the best of my knowledge and belief,a true and complete statement of all campaign
❑ finance activity,including contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents the
campaign finance activity of all p.s snssayting under e authority or n be alf of this candidate in accordance with the requirements of M.G.L.c.55. /
Date: /jam( (202Z(Candidate's signature)
Signed under the penalties of perjury: //J�1�J11
SCHEDULE A: RECEIPTS
M.G.L. c. 55 requires that the name and residential address be reported, in alphabetical order,for all receipts over$50 in a calendar
year. Committees must keep detailed accounts and records of all receipts, but need only itemize those receipts over$50. In addition, the
occupation and employer must be reported for all persons who contribute$200 or more in a calendar year.
(A"Schedule A: Receipts" attachment is available to complete,print and attach to this report,if additional pages are required to
report all receipts. Please include your committee name and a page number on each page.)
Name and Residential Address Occupation & Employer
Date Received (alphabetical listing required) Amount (for contributions of$200 or more)
Line 9:Total Receipts over$50(or listed above)
Line 10:Total Receipts$50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD E- Enter on page 1,line 2
* If itemized receipts of$50 and under,include them in line 9. L9ne 10 should include only those receipts not itemized above.
If you haveP Page 2
SCHEDULE A: RECEIPTS (continued)
Name and Residential Address Occupation & Employer
Date Received (alphabetical listing required) Amount (for contributions of S200 or more)
Line 9:Total Receipts over$50(or listed above)
Line 10:Total Receipts$50 and under* (not listed above)
Line 11: TOTAL RECEIPTS IN THE PERIOD Enter on page 1,line 2
* If you have itemized receipts of$50 and under,include them in line 9. Line 10 should include only those receipts not itemized above.
Page 3
SCHEDULE B: EXPENDITURES
M.G.L. c. 55 requires committees to list, in alphabetical order, all expenditures over$50 in a reporting period. Committees must keep
detailed accounts and records of all expenditures, but need only itemize those over$50. Expenditures$50 and under may be added together,
from committee records, and reported on line 13.
(A "Schedule B: Expenditures" attachment is available to complete,print and attach to this report,if additional pages are required to
report all expenditures. Please include your committee name and a page number on each page.)
To Whom Paid
Date Paid (alphabetical listing) Address Purpose of Expenditure Amount
I�� (G C kci 7\C.► c�l. 44 4 ���� Ss-C , a,
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Line 12:Total Expenditures over$50(or listed above) S-YG
Line 13: Total Expenditures$50 and under* (not listed above)
Enter on page 1,line 4 -* Line 14: TOTAL EXPENDITURES IN THE PERIOD Sig) ,p v
* If you have itemized expenditures of$50 and under,include them in line 12. Line 13 should include only those expenditures not itemized
above. Page 4
SCHEDULE B: EXPENDITURES (continued)
To Whom Paid
Date Paid (alphabetical listing) Address Purpose of Expenditure Amount
Line 12:Expenditures over$50(or listed above)
Line 13: Expenditures$50 and under* (not listed above) q
Enter on page 1,line 4-4 Line 14: TOTAL EXPENDITURES IN THE PERIOD
* If you have itemized expenditures of$50 and under,include them in line 12. Line 13 should include only those expenditures not itemized
above.
Page 5
SCHEDULE C: "IN-KIND" CONTRIBUTIONS
Please itemize contributors who have made in-kind contributions of more than$50. In-kind contributions$50 and under may be
added together from the committee's records and included in line 16 on page 1.
Date Received From Whom Received* Residential Address Description of Contribution Value
Line 15: In-Kind Contributions over$50(or listed above)
Line 16: In-Kind Contributions$50& under(not listed above)
Enter on page 1,line 6- Line 17: TOTAL IN-KIND CONTRIBUTIONS
* If an in-kind contribution is received from a person who contributes more than$50 in a calendar year,you must report the name and address
of the contributor;in addition,if the contribution is$200 or more,you must also report the contributor's occupation and employer. Page 6
SCHEDULE D: LIABILITIES
M.G.L. c. 55 requires committees to report ALL liabilities which have been reported previously and are still outstanding, as well
as those liabilities incurred during this reporting period.
Date Incurred To Whom Due Address Purpose Amount
Enter on page 1,line 7-► Line 18: TOTAL OUTSTANDING LIABILITIES(ALL)
Page 7