HomeMy WebLinkAbout2017 Snow Dockser - Statement of Organization � Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE , ��,�r ;;_;;
MUNICIPAL FORM i 0 W N C L�t�K
;<,��DiNG, M�;SS.
Commonwealth Office of Campaign and Political Finance
of Massachusetts
File with: City/Town Clerk or Election Commission ��
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amended,of the organization of a
candidate's committee as follows:
CANDIDATE: Full Name: , � �
�
Residential Address: �'Q �2���
City/State/Zip: �.�� �-'�'�
E-Mail Address: L, S`y� � �,� � � hone#: �g� g,(��Q��S
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Title:
District:
COMMITTEE: Name of Committee: �.�-.d ._ s Lv 1" �� �
cx� n�/
(The name of the committee must include t e candidate's last name)
Committee Mailing Address: ����r
a
City/State/Zip: Phone#:
OFFICERS:
Chairman: �y� a Treasurer*: ��
Residentia]Address: 1 � � Residential Address: Lo
City/State/Zip: �f ���L City/State/Zip: L` � D��� �-
Phone#: ��,,_O�� Phone#:7��yy y(���� Email: (� / �
K�N'1[LlAI1NU�/ U°Lr17,LN�h '
*A ublic em lo ee ma not serve as treasurer of an olitt al committee see reverse.
Other Officer/Title: Other Officer/7'itle:
Residential Address: Residential Address:
Ciry/State/Zip: City/State/Zip:
Phone#: Phone#:
(Complete and attach a Form CPF M A 101,if necessary,with other officers and finance committee,if any.)
I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her
behalf. I am aware that candidates aze required to keep detailed accounts and records of all campaign finance activity for a period of six yeazs from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY:
����_ Date: Z$���
Candidate's signahire
I hereby accept the office of Treasurer of the above-named committee.I affirm that I am not a public employee as defined by M.G.L.c.55,s. 13.I understand
that: 1)I am subject to certain duties and liabilities under M.G.L.c.55, including the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of six years from the date of the relevant election;2)if after my acceptance of this o�ce I become an
appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED UNDER THE PENALTIES OF PERJURY: � C ,� p a . /
T �v� Date:
Treasurer's signature
I hereby accept the o�ce of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
� �1�� Date: I /�
Chairman's sig re a/ �`�/