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NAME OF <br />CPF ID t!: <br />The Commonwealp of,Aawcbuoett0 <br />. ELECTED CITY, WARD AND TOWN POLITICAL, COMMITTEE REPORT <br />WARD (if applicable): <br />PARTY: bC,1 J6/C ffAT DATE OF REPORT: r7/ 11- ;?a / ?-- <br />INDICATE THE PURPOSE OF TIES REPORT BY CHECKING THE APPROPRIATE BOX BELOW: <br />Ig STATEMENT OF ORGANIZATION ❑ CHANGE OF OFFICERS) EIMEMBERSHIP UPDATE <br />sbout this report to thefour offices fisted below. File the original with she OJ%w of Campaign and Politica/Finance, anditle wr a olithis report with the <br />!her throe ti icea listed <br />1. Office of Campaign and Political Finance 2. Secretary ofthe Commomvealth, William Francis Galvin <br />One Ashburton Place, Room 411 Elmfi. Division <br />Boston, MA 02108 One Ashburton Place, Romn 1705 <br />(617) 979-8300 / (800) 462-OCPF (toll free in MA) Boston, MA 02108 <br />ocpf@cpf state.ma.us / http://www.mws.gov/ocpf (617) 727-2826 / (800) 462 -VOTE (toll free in MA) <br />electioas@seastate.ma.us / httpJ/www.=.Mw.m&us/elelelcidLhtr <br />3. State Party Committee Headquarters <br />City Ward Commluee secretarno meal abo, <br />Chairperson: '•/ 1 i'Vials <br />4. City/ Town Clerk or Election Commission <br />the chairman ofdh city mmmiaee.fthepoli#calparty which It rewerenu(CF. 52, Sec. 5). <br />yo a4ie ST <br />G/S6' 7 <br />Nmx Street Adbess Ciry/StmelLip e -M.1 Telephwua <br />- 3178 <br />/few '5jof o Olz'" d' <br />ecretary: A Bre �Cy�K�f�: aL'T <br />Nasse Strep Address Cdy/St wzP a -moll Tetq+ho s # <br />/� 1Zk"1NG .N.4 KEL6s 3847✓4YfAo • <P44 <br />Treasurer: fN7AL"e 5&4Z%0 t 2 544bY Fhf t. LW 0/867 761- 941V-44 <br />Nome Street Addvas <br />Ctry/3mteZip <br />e -Mail Telephone # <br />hereby submit this list ofofficers and members (including associate members) ofthe above-mentioned commune W the Secretary ofthe Commonwealth in <br />,contacts with Ch. 52, Sm. 5 oftheMRsachosetts Geaeml Laws. <br />Data: - //-'7 2— <br />rt to o1E,e of Treasurer.fthis commi0ee. I understand that I. subject W certain duties and liabilities under M.G.L. c. 55, including the <br />.f campaign financereports. I sum also aware that an appointed public employce spay not serve as treasurer of a political committee. This <br />required to be filed with the Office of Campaign and Political Finance as provided in M.G.L. c. 55, s. 5. <br />Date: <br />LIST OTHER OFFICER'S NAMES, TITLES, RESIDENTIAL. ADDRESSES AND ZIP CODES BELOW: <br />Elected Ward and Town Political Committee Report Pelle 1 <br />