HomeMy WebLinkAbout2012 Curtis - Year End �
Form CPF M 102-0: Campaign Einance �{�-I VED
Munici alForm ��"'" CLERK
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Ciry or Town of. Ie�D�u G
Pleaee print or type all infolmatioq except eignatures.
Fill in daza: Month Day Year Month Day Yw
Reporting Period Beginning i / �i y EndinB / Z 3 i �� /z
Type of Report: (Check One)
� Bth day preceding � 8th day preceding election � 30th day following election �20th day of January
preliminary/primary (Town or Spaial) (Year-End Report)'
Pursuant to M.G.L.,Chapter 55:
L I certify that I am a candidate for or hold Municipal Office.
2. I urtify lhnt 1 have not received eny contribu[ians,made any ezpmdiNtts,or incurrcd any obligations during this
rcporting period,and do nat Aave e campaign fund in existence. � -
3: I cenify that I do not have a political committee.
DATE 1. SIGNATURE II. RESIDENTIAL ADDRESS III. OFFICE SOUGHT
Si nedunderthepenaltiesof0erjury (Stree[andNumb<r)
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