HomeMy WebLinkAbout2012 Dubois - Year End �
FormCPFM102-0: CampaignBinanceReport�F�EIVED
MunicipalForm TC'IN CLERK
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Please print or type all infartnation,except signanues.
Fill in datu: Month Day Yw Monih Day Year
Reporting Period 8eginning / � > Ending i a 3 i i 2�
Type of Repon: (Check One)
� 8th day preceding � 8[h day preceding election � 30th day following election � 20th day of January
preliminary/primary (Town or Special) (Year-End Report)�
Pursuant to M.G.L.,Chapta 55:
1. I mrtify thaz I am a candidate for or hold Municipal Office.
2. I certify ihaz t have not rcceived any mntributians,made any ezpendiNrcs,or inwrted any obligations during this
repotting period,and do not Aave e campaign fund in existence. �
3: I certity that 1 do not have a politicel commit[ee.
DATE I. SIGNATURE IC RESIDENTIAL ADDRESS III. OFFICE SOUGHT
Signed under the penalties of perjury (Street end Number)
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