HomeMy WebLinkAbout2015 Docktor - 30 day � .
Form CPF M 102-0: Campaign Finance Rep;Qq�t I VED
Municipal Form ; �W N C L E R'K
OtTee of Campai�s aod Politint�oanee ;_.,i�j(�(�j. �"��5�.
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City or Town of: �C��,�N�
Please print or type all informarion,except signatures.
Fill in dates: Month Day Year Month Day Year
Reporting Period Beginning .'� �( (5 Ending � �—] � S
Type of Report: (Check One)
� 8th day preceding � 8th day preceding election � 30th day following election � 20th day of]anuary
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 1 have not received any contributions,made any expenditwes,or incurred any obligations during this
reporting period,and do not have a campaign fund in existence.
3. I certify that I do not have a political committee.
DATE 1. SIGNATURE II. RESIDENTIAL ADDRESS III. OFFICE SOUGHT
Si ed under the penalties of perjury (Sueet and Number)
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11/97
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