HomeMy WebLinkAbout2017 Arena - Statement of Organization � Form CPF M101: STATEMENT OF ORGANIZATION
-- � CANDIDATE'S COMMITTEE
MUNICIPAL FORM F;��;�I,�;_;�
Commonwealth Of�ce of Campaign and Political Finance �+f ������_r ��p,�,�t�K
of Massachusetts (y'�-��I t��• 1 ,�S�:
File with: Ciry/Town Clerk or Election Commission
NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as amended,d�'th�bi+g�ni�a�ionrof a�''�� �
candidate's committee as follows: �
CANDIDATE: Full Name: �Q�� J, A-ZL'�J 1�
Residential Address: 'Z� �����V�y 5 p j�y�J�
City/State/Zip: R��!��yn%G, 7�/!(�{- C� I �`b �-'
E-Mail Address: �j�.� �1 ��.(_,tij/,}��,�i i�-f—C(Z�`L�G%i�f/�i(,�C0�'%Phone#: �'��-(�`I`,�j 6 Ti y
Party Affiliation: (If applicable)
OFFICE SOUGHT/PURPOSE:
Titie: i�17�� C�� S�L�C� l� ��
District:
COMMITTEE: Name of Committee: CC I�M.�i i`�' � r-`�� ( `)L l�}-� �iz L]�1�
L
(The name of the commit[ee must include the candidate's last name)
Committee Mailing Address: � � ,���j/1,v L�-3 .D�J�
1�J�
City/State/Zip: i2������ �1i1 `� �1 �� Phone#: ���'��� •-3J-�i',�.
OFFICERS:
Chairman: \�'��� � �-h�����J��}' Treasurer*: G�y.�-(,.� L'ylJGl: r�EN�-
Residential Address: '�� ���J(,�s ��iV� Residential Address: 'L Ey ����-(�L�S p��JL
City/State/Zip: I�(,'�t'T U�ilV�r �"1/'� l'1 6� City/State/Zip: �l L��� �./��' (� ,�(u �
Phone#: � C� � �(.�(.t-'J�J�/'L, Phone#: '��j f"���(�'��(fEmail:
'G � /
*A ublic em lo ee ma not serLe as treasurer of an olitical committee see reverse.
Other OfficedTitle: Other Officer/Title:
Residential Address: Residential Address:
City/State/Zip: City/Sta[e/Zip:
Phone#: Phone#:
(Complete and attach a Form CPF M A]Ol,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 tl�an one committee on his/her
behalf. I am aware that candidates are required to keep detailed accounts and records qP'all.campaign finance activity for a period of six years from the date of
the relevant election. �'� la r �
i
SIGNED UNDER THE PENALTIES OF PERNRY: ( i; `� /�
�-- � t�n ��; - l.��---� Date: �����`J� '7
Cand��a e's sign r�
I hereby accept the office of Treasm�er of the above-named cominitt�e.I affi�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.I�c155,inclu�ding�the timely filing of campaign finance reports and keeping detailed accounts
and records of all campaign finance activity for a period of six, e�rs 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 noti�f�y 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 PERNRY: '' /
� r�•fi,�i�:' .�✓- Date: f�J �/ I7
Treasurer's sigt�ure
I hereby accept the office of Chairman of the above-named committee.
SIGNED UNDER THE PENALTIES OF PERNRY:
Chainnan's signature Date: