HomeMy WebLinkAbout2019 Dockser - Statement of Organization � Form CPF M101: STATEMENT OF ORGANIZATION
CANDIDATE'5 COMMITTEE
MUNICIPAL FORM
�,,,»mo�,.r,i�n Office of Campaign and Political Finance� �� �
ofMassachuseus
������������ c�„�;r�„����«a,�.�������,c����������a�, 2d�y ,,�, —7 Pi1 4� 28
NOTICE IS IIEREBY GIVEN in accordance with the provisions of General La�vs,Chapcer 55, as mnended, ofthe organizetion ofa
candidatds mmmittee as (ollows:
CANDIDATE: Foll Vamc Mark Dockser
Rcsidcnlial Addrcss�. 110 Beaver Road
Ciry�IS�mciZip: Reading MA 01867
G-Muilnddrcss�. mdockser@gmaiLcom Phnnea: 6ll-671-5828
Pnny�ffGelion�. �Ifapplicoble)
OFRICE SOUGHT/1'URPOSE:
7'i�le: SeleCt Board Member
Disvici�. Reading
C'�MM�7'7'EE: NmneofCnminiucc Mark �ockser Campaign Pond
fThe nume of�he commiuee must IncluJe ihe cnnAldote's lu�name)
Commiuee Mailing AJdress�. I10 Beave� Roaa
City/Siaie/ZIO'� Reatling MA 01867 Phoncn�. 781-942-7566
OFFICERS:
Chairman: Shawn Brandt Treasurer*: Marc Moll
2aiocm��el Adtlress�.231 Franklin Stree[ feesWeniinl ndJress: 41 Richards Road
C�uc�Sm�cr]i0�� Reatling MN 01867 Clic:s�a�e!Iip: Reading MA 018fi7
vhonca_ 6ll-833-0372 Phunca�. 781-670-9007 Gmaif. mollmlm@gmaiLmm
M uhLcein lo�c nmseevcuvcasur�ntam oliticolwmmluec seerm�erse
ome�orr,adrne: on,��omu,n��n�,
Rcadcnuel AQdress�. NesiJemial Adtlas.
Gry/S�etc/Zlp�. Clic;Siaic/Zlp'.
Phune p� Phanc P�.
lCoinplele an�aitach a Fumi CVI'M A I01.il neceswrv�.�cilh ulherul(cers and flnance emnmlltee.ifanv.)
I hereby wnsenl m�he Illing of�hls mmmince I undcr.ttand thal u cundldme shall nut eive cnnsenl m�he o�genizeliun nf inure than one convniuee on his/her
buhol( I um oxarc Ihat cnndidatcs e�c rcqui�rd�u kcc�dcmilcd accuunLa ond rmords nl all compaien fnancc nctivlty f�r o pc�iod of sis years Gom Ihc dmt ol
thc mlccam dccllon.
SIG6F.D UVDh:k'I71L' NBNACfIF.$Of PF:N.NRV�.
—��� !�'� D'ale: �/5���
Condidotc's signa�urc
1 hereh.accept the olLce nl Tretiureruf iha uhove-�umed wmmiuee. 1 altirm�hat 1 am�nta publiv employee os delined by M.QL.a 55. s. 13. I undcrslentl
thac I7 I am subjea m ccrtalv dmics and liabililics u�de�M.G.L.a 5i, inGudine thc timcl��fli�g of campoi�n fnenre�cporls and kceping de�ailed accnun�s
und recurds of ull coinpoign tinance atliciq� for u period of six ytars Gmn 1he date nftha rcle�-ant eleeLion;21 i(ofter nq-occep[ance o�this ofl'ice I hvcoma an
appoinl d pubfic umplocx.I mus�resi�i this posltiun ond notlly OCPF ofim msievetlon:und 3)a candldatc mey no�sen�c as treasu�er nfiht poliiical
comnilueeorganliedonhlc�herhehalC � � < �� /J
SIGNEDUNDP.R'1II13PHRAl'fIFSOP'PP.ItJ1ikV: / . // n
l��' Dat¢ ���/l
7easurerS signaWre
I hercby acccpt thc officc ofCh�rzman ot�hc abovc-nomcd mmmince./. ��
SIGNEDUND�12'fIIBPENACI'IESOh'PEItJURY�. -� - - —
i �
Chairma�e� Uate: '/�
�