HomeMy WebLinkAbout2017 Halsey - Statement of Organization � Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'S COMMITTEE ;:�i ��1 y��
MUNICIPAL FORM ��O��i ����K
�` �t�DING. MASS.
c�n,�„o„��zdi�n Office of Campaign and Political Finance
of Massachusetts
File with: City/'Town Clcrk or Elcction 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: ����,� �.��5 y� �
Residential Address: 7 S �j�,J f? �0�� '
Ciry/State/Zip: ��j,�f(,� Q�g(p�
E-Mail Address: ���f��-�l�S� � � I�f P I Z OnI /���-T Phone#: ?g"�- 9�S'S 71 S
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Title: ���7M��
District: (>�,,�,� �f � �n!(,.
COMMITTEE: Name of Committee: Q����££ � �C£CT �Ol-lnf ��fH'!S£S/
(The name of the committee must include the candidate's last name)
Committee Mailing Address: /�g L G�£� J r v 1�F r "
(
City/State/Zip: ���i��� � O 1 ��7 Phone#: �¢I-p'Yy' 3�3
u
OFFICERS:
Chairman: `f G/�� J��S�Y Treasurer*: •
--I G
Residential Address: "�5� ��fQ �vA� Residential Address: �7 D UwE(� St A�iT /
City/State/Zip: �f�/�(y � �l b 7 City/State/Zip: �f�D/�f G � ����
Phone#: '�DI ����5� 5 7S5 Pho°e#:781'�-Y9-3�5 3 Email: �jCNAP77� Y�-I�CX?• CG/'�
*A ublic em lo ee ma not serve as treasurer of an olitical committee see reverse.
Other Officer/Tide: Other Officer/Title:
Residential Address: Residential Address:
Ciry/State/Zip: Ciry/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 LTNDER THE PENALTIES OF PERJiJRY:
Date: � �� /�
Candida e's si ture
I hereby accept the office of Treasurer of the above-named committ e.I am not a pub ic employee as defined by M.G.L.a 55,s. 13.I understand
that: I)I am subject to certain duties and liabilities under M.G.L.c. 5, including the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of si e s from the date of the relevant election;2)if after my acceptance of this office I become an
appointed public employee,I must resib 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 iJNDER THE PENALTIES OF PERJURY: � Date:
/b /
Treasurer s signature
I hereby accept the office of Chairman of the above-named com 'ttee.
SIGNED UNDER THE PENALTIES OF PERJURY:
2 Z�°/
Chairman' signature Date: � �