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.� � A�1102-0: Campaign Finance Report
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Please print or type all information,except signatures.
FiU in dates: Month Day Year Month Day Year
Reporting Period Beginning__ f v I Zc� 3 Ending �.Z 3 1 � I 3
Type of Report: (Check One)
� 8th day preceding � 8th day preceding election � 30th day following election � 20th day of January
preliminary/primary (Town or Special) (Year-End Report)'
Pursuant to M.G.L.,Chapter 55:
I. I certify that I am a candidate for or hold Municipal Office.
2. I certify that I have not received any contributions,made any expenditures,or incurred any obligations during this
reporting period,and do not have a campaign fund in existence. �
3. I certify that 1 do not have a political committee.
DATE l. SIGNATURE II. RESIDENTIAL ADDRESS III. OFFICE SOUGHT
Signed under the penalties of perjury (Street and Number)
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