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Form CPF M 102-0: Campaign Finance Report RECtIV.ED
MunicipalForm (OWNCLERK
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om�.arc.mn.�e�.�aeorr�.ivm.��. �aDING. MA55.
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CityorTownof: /�( ��T Y i ^�
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Pleaze prin[or type all infortnation,except signaNrts. ''�.
Fill in dams: Month Day Year Mamh Day Year � -(
Reporting Period Beginning 3 ���?! � Ending � -1 1 ,�.> (J
Type of Report: (Check One)
� 8[h day preceding � Sth day preceding election 30th day foliowing elec[ion � 20th day of January
preliminary/primary (Town or Special) (Year-End Report)
Pursuant ro M.G.L.,Chapter 55:
I. I certify that I am a candidace for or hold Municipal Office.
2. I certify that I have mt received any conhi6utions,made any expendimres,or inwrted any obligations during this
reponing period,and do not have a campaign Pond in exis�ence.
3. i rertify that I do not have a political committee.
DATE � 1 SIGNATURE IL RESIDENT7AL ADDRESS 1[I. OFFICE SOUGHT
Si e n er[he penalties of perjury (Sneet and Number)
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11/97
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