HomeMy WebLinkAbout2012 West - 30 Day �
� Form CPF M 102-0: Campaign Finance Report
Municipal Form
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QlY Of TO WO O�:
Pleaze print or rype all infolmation,a<ept signatures.
Fill in dates: M th Day Year Month Day Year
ReportingPeriodBeginning 27, 20�'1 Ending !�n-n1 �� Zq� 2
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Type ofReport: (Check One)
� 6[h day preceding � Bth day preceding eleclion �th day following election � 20th day of lanuary
prtliminary/primary (7own or Special) (Year-End Report)-
Pursuant to M.QL.,Chapmr 55:
I. 1 cenify that I am a candidate for or hold Municipal O�re. .
2. I<ertify that 1 have mt«ceived any contributions,made any ezpendimms,or incurted any obligations during this
reporting period,and do not have a campaign Pond in exiscence. �
3. I certify Nat I do not have a political committee.
DATE I. SIGNATURE ll. RESIDENTIAL ADDRESS 111. OFFlCE SOUGHT
Signed under[he penal[ies of perjury (Sheet and Number)
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11/97
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