Form CPF M 102: Campaig~Finance Report Municipal Fo~$~1~Pr ~~ret~~~~ Office of Campaign and Politic~.l\7 ~t... lui u~ 30 PH f: 07. ~s- t'\q.a~.

Transcription

1 Commonwealth of Massachusetts Form CPF M 102: Campaig~Finance Report Municipal Fo~$~1~Pr ~~ret~~~~ Office of Campaign and Politic~.l\7 ~t... lu u~ 30 PH f: 07 File with: Citv or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning ate: or Ending ate: 10 (L:J { l.,._ Type of Report: (Check one) 0 8th day preceding preliminary }Q"sth day preceding election 0 30 day after election 0 year-end report 0 dissolution W\U...tN1 f;. wa-,6hs-"- Cc"" -htu: ll:l u~ &! L. - w Q,, ~.. s::: Candidate Full Name (if applicable) Committee Name Cnf Cou.Vi.tl w t-v fl (J.. -"( L-/tv tj W,-1\l.-t.AACC Office Sought and istrict ( ct fotl\&~1 AVe Residential Address Name of Committee Treasurer ~s- t\q.a~.~ ~-(/~ Committee Mailing Address ~l()"f ~l~ll~(l.,b~{fl G,a..-1~ it,.. C;)J-4 /., f..:j\j- PATS~ r-j ~ 6.J-1\dlt... ro.v1 Phone# (optional): Phone # (optional): SUMMARY BALANCE NFORMATON: Line 1: Ending Balance from previous report C2= Line 2: Total receipts this period (page 3, line 11) 2..~~. 0~ Line 3: Subtotal (line 1 plus line 2) 2..) ~6. C-0 Line 4: Total expenditures this period (page 5, line 14) l2f2q. 15 Line 5: Ending Balance (line 3 minus line 4) =tutb. ss Line 6: Total in-kind contributions this period (page 6) Line 7: Total (all) outstanding liabilities (page 7) -G- c:::::::::: c=c) ~~~--~~~==~====~ Line8: Nameofbank(s)usect:l ~W~.sij~u o;a;)~ Affidavit of Committee Treasurer: certify that have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign finance activity, including all contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting under the authori~f of this comm~ith the requirements ofm.g.l. c. 55. /o/ 1o//7 Signed under the penalties of perjury: ~./..~. (Treasurers signature) ate:.._ FOR CA~ATE FU!S.GS Q~LY: Affidavit of Candidate: (check box only) Candidate with Committee and no activity independent of the committee ij" certify that have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign finance activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements ofm.g.l. c. 55. have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during th~s reporting period. Candidate without Committee.QR Candidate with independent activity filing separate report 0 certify that have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign finance activity, including contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign finance activity of all persons acting ~~~the.allth ori t~ half of this committee in accordance with the requirements of M.G.L. c. 55. A _,/ "~ :::---- ate: [0 &. T Signed under the penalties of perjury:.;:..u""ndidates signature) --

2 SCHEULE A: RECEPTS M G.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts over $50 in a calendar year. Committees must keep detailed accounts and records of all receipts, but need only itemize those receipts over $50. n addition, the occupation and employer must be reported for all persons who contribute $200 or more in a calendar year. (A "Schedule A: Receipts" attachment is available to complete, print and attach to this report, if additional pages are required to report all receipts. Please include your committee name and a page number on each page.) ate Received ro/ri1 /,t- Name and Residential Address (alphabetical listing required) t~ ~-\ 0-\t..;- \(\ llaj\ ~ w>a"1 (1\"TUa~l~ t-1\ j"ls l ~1\~o..., CC...A.\tQ_"1.CN > C-1-\G~... ~ i.nf\-( ~~~t==n~t. o1r l Oe.e;t..y 0~~1 t (;6 ~,4:\.Q...t-~ J!._p #. ll.( Ptm.rt~Q M+- o12--0 f2.etj~e: ep 1,...J E~~G)" 2..Z. )..;. f-1 c.-\ f.,,.~ 1/V t2. 0, ~~TtS~\~0 t ~ g.,r( l h.u~ ~. ~~ f \..t>t..-\e;.._,a $)Q_ fj, tts_~, a o.~ o ~ ~ f2..1 c... \l-() a.. e. N 1-\ -\-V t;t1j, ~ 1.-ft t?;s.:l.o Wtl&~<Q-0 M4 0\2-.? zo,.., 1-1 ~.., w 0!L 1> Mf\---v""1 ftt{3.ft~ 14\- nl \ Q.fun.(_ """~S... tl:;;> Ct.t~OJ~ $\ l~l> +--1Pt Oll...Lf 0 ~ t-j-1st-l 4 \ fl\t...l i)ul.-j4c)1a,..l1 "tn P-0 Urvo{ ~?ll..yo ~4lllh.""LV Sc:..Act.AfO\J\ z.. G ~\"i> ~ oe... - ~. \TS ~~ i--1a 0 l"lo rw~ SA(SH~t1 t?v V "im -;r \>11fSF1~ 0"\{\ 6t~ Line 9: Total Receipts over $50 (or listed above) Line 10: Total Receipts $50 and under* (not listed above) Amount ~ ~ ~ 1~100 ~ 1 2.) oo. l1 L~b l Occupation & Employer (for contributions of $200 or more).,, Line 11: TOTAL RECEPTS N THE PERO 1-z,~ ~t. ~ ~ Enter on page 1, line 2 L*...,.f.,..y_o_u...,..h-av-e-it_e_m-,-z-ed-,--re-ce-:-p_t_s o- f::-:$, an-d:-u-n-de-r,.,, -nc-lu_d_e-th,...e_m,_,i,-n...,., li,-ne~9=.=l==ne==l o=s=h=ou=,~ld mclude only those rece1pts not temized above. Page2

3 SCHEULE B: EXPENTURES MG.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 in a reporting period. Committees must keep detailed accounts and records of all expenditures, but need only itemize those over $50. Expenditures $50 and under may be added together, from committee records, and reported on line 13. (A "Schedule B: Expenditures" attachment is available to complete, print and attach to this report, if additional pages are required to report all expenditures. Please include your committee name and a page number on each page.) To Whom Paid ate Paid (alphabetical listing) Address Purpose of Expenditure Amount 4/3o/J"fl ~C-:~<h.U. f>nl <?.o ~-o)c t:;c>fs Ct\~S t&. S~.w{.J "1"&f ~ ~q -1s-l \./\!\ -otw ~.cb"&oo "1 ~ vc C.,o!N Wl2.o& ~ \2.-~ 1"-\~L.t..S--1~-r- (J tt. F \ t-" t 0,.~ llo/z/1~ 14 ~oo.ool ~!, 1L-L- wa... t<:f t rom. 0u( P..ve b 1-\.,.-- "Ot$nal:) ~ et~+ ~ t-1~5~t:."-~ l6oo.cqj Line 12: Total Expenditures over $50 (or listed above) 1 1?~<1.1,.- 1 Line 13: Total Expenditures $50 and under* (not listed above) B- Enter on page 1, line 4 -J Line 14: TOTAL EXPENTURES N THE PERO l is~~ ".. *f you have temized expenditures of$50 and under, mclude them m hne 12. Lme 13 should mclude only those expenditures not 1terruzed above. Page 4

4 !! i: i icommonwealth! bf Massachusetts Form CPF R 1: temization of Reimbursements Office of Campaign and Political Finance f Office of Campaign and Political Finance [One Ashburton Place, Room 411. Boston, MA i(6 17) Please itemize any reimbursements by detailing the date, payee, address, purpose and amount for each expenditure made by the person being :; i reimbursed. The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount shown on f~he reimbursement form. ~ i, ~ ate of Reimbursement: 1<:> t_2. Zt ~ ~arne oflndividual Being Reimbursed: 4>, \ wa.. bh-1- ;: >Committee Name: lcc?m.f-(..,~ -n ~e-v\ f?.rl.l W~br\"s": (. ~ ~PF Number (if applicable): ~ {_ Ft Telephone Number (optional): TEMZE EXPENTURES N EXCESS OF $50 r ate Paid Vendor Name Vendor Address Purpose of Expenditure Amount b/24{,,_1 lel.~~~ 2~1- Fto.-,,r 5". ~~-~ 415 i M13 "nsr:,~ ~ OOJ S~o. 1 1~~-H lut7/n- l llvu ~l"~>~ ~-r r 61- w ~~1... (... ~ s n~ > """~v ~ T5Fte.." t-14 O/~ lq h~kr <7 \)1\ft..t:~ sst) ~e:.~ vrvr 1\oX C"JZ-0 > 2 {t ~y:., \C\ 0 1-1" o t"].) =~-e. qf,~l :r lw:s- ~~,t....- flo_."~ i: tt1- w. ~.l\~~1<>t-~~c. ~- $~ sn ~ a:."l 1- \)Tl>flo.- ~ 12J\ ~tgf-)~ 1(1\.oo j Of ~r,!trt ~l :> tj{l."\1.\- Z&f 1- t-.7ot.."lt-j Sr. l~ /to6...;j ~. t:.tl. 0.;; e- ll<to.~ l ~ lnsft t.::\-0 ~ 0 12.> l:>je:u<r (nclude items listed on Page 2)... Line 1: Expenditures in excess of $50 (itemized above): \4oc c-o.\ r t Line 2: Expenditures $50 or under (not itemized): -e--; ~ Line 3: TOTAL AMOUNT REMBURSE: C1oO.o~ " signed under the penalties of perjury: \ ~ZnL,~~ ate Please prepare a separate report for each reimbursement check issued by the committee. cj. 1.. ~ 1. i.....! to b~ /11-

5 : ate Paid Vendor Name 1/v;,_(, r WP9~~ - l l \; ll l H li!l t; TEMZE EXPENTURES N EXCESS OF $50 Vendor Address Purpose of Expenditure U> fi>a..ls~,...,.. l". (7,%-r, e:w::::> 6-A Of2,M Page 2 Total (add to Line on Page 1): 1 fi\u> Si6...,., Amount ::; ~- 5~ ~ l _, - Page 2ll - ll : il

6 ~. - ;!: ii li :Commonwealth i.bf Massaehusetts l.: ioffice ofcampaign and Political Finance ; One Ashburton Plaee, Room 411 ~ Boston, MA ~ (617) \ Form CPF R 1: temization of Reimbursements Office of Campaign and Political Finance Please itemize any reimbursements by detailing the date, payee, address, purpose and amount for each expenditure made by the person being,. teimbursed. The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount shown on ii the reimbursement form. ~[ ~ t ~ ~ ate ofreimbursement: io n lr~- ~ i ~arne oflndividual Being Reimbursed: <bill wt.tb.h-r.. Committee Name: i:.cpf Number (if applicable): l eon~ ~ 1b ~ l!> t-l- t.v Z- { (1 1"\r 1\.:) ~ Telephone Number (optional): TEMZE EXPENTURES N EXCESS OF $ ! ate Paid Vendor Name Vendor Address Purpose of Expenditure [;-;] ~~~P~Zo $"{!;~~ 7.::::> "fo"-"-s-\.lzl" "-~ Yl"\12.-0 St 6 ~...:J fi\sfj~ ~ OlZv l!; (nclude items listed on Page 2) + Line 1: Expenditures in excess of$50 (itemized above): \ ; t { it ;j Line 2: Expenditures $50 or under (not itemized): l it,, ;: Line 3: TOTAL AMOUNT REMBURSE: i.l p. r dundorth pmolti.,ofp~ / o;:..!#~ Amount. l:j~ blo 6oo.C7q l l ~ ~ 60c?.ooj.. f Signature of Candidate Trb surer Please prepare a separate report for each reimbursement check issued by the committee.