HomeMy WebLinkAbout2013 Dubois - 30 Day �
Form CPF M 102-0: Campaign Einance ReportRECEIVED
Municipal Farm �OWH CLERK
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City or Town of: (\ E{�Y�/�J�� 1
Pleau print or type all infom�ation,exapt signamres.
Fill in dates: Mon�h Day Year Month Day Yesr
ReportingPeriodBeginning f�'�¢�c.¢� L(o � Ending �n�„f 22 Z i�
Type of Report: (Check One)
� Bih day preceding � eth day preceding elmtion � 30th day following eiection � 20th day of Januery
prcliminary/primary (TownorS cial
p� ) (Year-End Repott)'
Pursuant ro M.G.L.,Chapter 55:
1. 1 mrtify ihat I am a candidate for or hold Municipal O�ce.
2. I certify thet 1 have no[rcceived eny wntributions,made any expendiNrcs,or incurrcd any obligations during[his
reporting period,end do not heve a campaign Pond in exisrence. �
3. I artify tha[I do not have a political commitcee.
DATE I. SIGNATURE II. RHSIDENTIAL ADDRESS III. OFFICE SOUGHT
Signedunderthepenaltiesofperjury (StrettendNumber)
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