HomeMy WebLinkAbout2018 VandenAkker - Statement of Organization � ;- � �Form�CPF M101: STATEMENT OF O1zGANIZATION �
CANDIDATE'S COMMITTEE ���;��1��:�
�' � MUNICIPAL FORM � �CJ��1.��' ��L���4
. � ����.�a � 9•��"�, ���h.
Commonwealth Office of Campaign and Political Finance
of Massachusetts
File with: City/Town C(erk 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: � e .�`o�
Residential Address: ���S���,P�` �vP 1��.�
e
City/State/Zip: � ��
E-Mail Address: Phone#: — ��� r
� Party Affiliation: �� (If applicabl )
OFFICE SOUGHT/PURPOSE:
Title: � , Q V�� i ��-�i
District: � ��� �� S
COMMITTEE: Name of Cnmmittee: , s � � r � e
(The name of the committee must include the didate's last name)
Committee Mailing Address:
.
City/State/Zip: ` � �� Phone#: � ��� �
OFFICERS: 6 0 � (�i'�-(�%_:- .y���
Chairman: i ` �. � Treasurer*: o
Residential Address: , � Residential Address: I SL ,�. �J
City/State/Zip: 7 ���b City/State/Zip: e C�1� �� (� I��/
Phone#: �. G ,� � I Phone#: Email: : 1 ���` ,�, (�/I
1 *A ublic em lo ee ma not serve as treasurer of an olitic ommi see reverse.
Other OfficedTitle: i I 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 awaze that candidates aze required to keep detailed accounts and recor s of all campaign finance activity for a period of six years from the date of
the relevant election.
SIGNED UNDER TI�PENALTIES OF PERJURY:
� Date: � �
C e s sign re
I hereby accept the office of Treasurer of the above-named ittee.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 li�bilities under . .L.c.55,including the timely filing of campaign fmance 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 office 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 iJNDER TI-IE PENALTIES OF PEI2JURY: C�L Date: O� O L S�/
Trea urer' signature /�
I hereby accept the office of Chairman of the above-named committee. `
SIGNED UNDER THE PENALTIES OF PERJURY:
-,
Chairman's signature Date: � ,� ��