HomeMy WebLinkAbout2017 Boivin - Statement of Organization � Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE �_ �i ,Y;�_��
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MUNICIPAL FORM j-�j�,�� �����
t'���{�G. M;SS.
Commomyealth Office of Campaign and Political Financ'e
of Massachusetts
File with: Ciry/Town Clerk or E(ection Commission "V �� ��' �
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: ��Gk (/��'�[,���4 t � �' `
� vrk
Residential Address: �� �S-��P L.cc.(��
City/State/Zip: RC'ciG� tVIG_ � It 0� O�v� 10/ ��� �77�
E-Mail Address: ��,�,� "�y�vl �w 41'u Cp I,� � CG� Phone#:
Party Affiliation: V N�Q G<<�.i/'P_� � l/� (If applicable)
OFFICE SOUGHT/PURPOSE:
Title: �C�po i l�Cj�(�(Vh��"�.'L
District: Z � � �
COMMITTEE: NameofCommittee: � C'���,,�jy�,,�I��C' f"b L/f=C �- ��/(�-i� ��'11�(l�l
(The name of the committee must indude the candidate's last name)
Committee Mailing Address: � !�' S C�,� f ��
1— 1-`l L_Q
City/State/Zip: �_ t-{�(�G � �(�Ln� Phone#: '�g( �(�—S��
OFFICERS: � �, � i.�, ,�
Chairman: ��C�1���. �,� �c f V�f�` Treasurer*: �� Q
Residential Address: � �5� � L��� Residential Address: l'� f,���.��V ��
City/State/Zip: ��i�q/l c� � � f Ciry/State/Zip: IL�Ct�(K� �� �(��7
Phone#: � Phone#: 7�� "�r 2�� Emai1: ' ` r ` �,[
�x( �OS — � � �.� f�-J�17 Iti1u�ctHNe�YatvN1�'IkC�CcNA�')l.
*A ublic em lo ee ma not serve as treasurer of an olitical com ittee see reverse.
Other Officer/Title: Other Officer/Title:
Residential Address: Residential Address:
City/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 are required to keep detailed accounts and records of all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER THE PENALTIES OF PERJURY: '-• , y
� �j � ,C.�4f-� Date: � O 2���
Candidate's signature
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.a 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 yeazs from the date of the relevant election;2)if after my acceptance of this office I become an
appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidat not serve as treasurer of the political
committee organized on his/her behalf.
SIGNED LTNDER THE PENALTIES OF PERJURY: / j G—. Date: .� (a U�y
Tr sure ' signatur
I hereby accept the office of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERJURY:
i�������%� � - _— ,
Chairman's signature Date: � � Z���