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Form CPF M 102-0: Campaign Finance Report '
Municipal Form -
Comm wealth Office of Campaign and Political Finance
of Massachusetts
��> Plea.re print or type all infi�rmation,except signuhires.
City or Town of: � C�!� �/� �
Reporting Period: Beginning: _ O/ /G/ �G/G, Ending: ��,�� Z/2 0�.� :
MM/DD/YYYY MMlDD/YYYY
Type of Report: (Check One)
❑ 8th day preceding preliminary/primary � 8th day preceding election ❑ 30th day following election(town or special) � 20th day of January(Year-End report)
Pursuant to M.G.L.Chapter 55:
1.I certify that I am a candidate for or currently 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 I do not have a political committee.
SIGNATURE RESIDENTIAL ADDRESS
DATE PRINT NAME Signed under the penalties of perjury (Street and Number) OFFICE SOUGHT
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