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��� Form CPF M 102-0: Campaigo �inance Report T��'�;N C�[DK
�W�l� Municipal Form pF; �� i'!,, N%�SS.
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Ciry or Town of:
Pleue print or rype all information,ez<ept signaNrcs.
Fill in dates: Monih Day Year Mon1h Day Y<ar
Reporting Paiod Beginning J 0.w 2° � Z Ending Ae�_ 20 1 2
Type of Report: (Check One)
� 8th day przceding � Sth day preceding election � 30th day following elenion � 20th day of lanuary
preliminary/primary (Town or Special) (Year-End Report)
Punuent ro M.G.L.,Chapter 55:
I. I certify that 1 am a candidate for or hold Municipal O�ce.
2. I certify that I have not rcceived any connibutions,made any expenditures,or incurt<d any obligations during this
reponing period,and do not have a<ampaign fund in exismntt.
3. I certify that 1 do not have a palitical committee.
DATE 1. SIGNATURE II. RESIDENTIAL ADDRESS III. OFF]CE SOUGHT
Signed under the penalties of perjury (Street and Number)
�_�3' l3 �,U�un/✓ Y". � 9�10.w�,es � �� �t e.ox..m� � p v,
11/97
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