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� Form CPF M 102-0: Campaign �inance Report r F��[��E p
MunicipalForm i ,'��✓�N CLERH
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Please prin[or rype all information,except signatures.
Fillindaces�. Momh Day Year Month Day Year
Reportmg Poriod Beginning I � 7 o i U Ending 2 �� � � ��=
Typyo eport: (Check One)�
Sth day preceding '=' StF.Cay preceding eieaion �' 30th day following election � 20Ih day ofJanuary
Ipreliminary/primary (Town or Special) (Year-End Report)'
Pursuan[[o M.G.L.,Chaprer55�.
I. I certify iha�1 am a candidam for or hold Municipal Office.
2. I mrtify thut 1 have no�received any connibucians,made any ezpendimres,or incurted any obligacions during this
reponing period,and do not have a campaign Pond in enisrence.
3. I mrtify that 1 do not have a political commiaee.
DATE I. SIGNATURE ❑. RESIDENTIALADDRESS fII. OFFICESOUGRT
Signed under[he penal[ies of perjury (Srceet and Number)
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