Form CPF M l02: Campaign Finan

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umc1pa orm u i.! NOV 1 Lo,, iL:J
Office of Campaign and Finance L __________
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ofMassachusetts
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Fill in Reporting Period dates: Beginning Date: l /j_lj f/
Type of Report: (Check one)
0 8th day preceding preliminary 8th day preceding election 0 30 day after election 0 year-end report 0 dissolution
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L_ __ CommiTreeName
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Office Sought and District Name of Committee Treasurer
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Residential Address Committee Mailing Address
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Telephone Nwnber (optional): I J Telephone Number (optional)

SUMMARY BALANCE INFORMATION:
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Line 1: Ending Balance from previous report
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51
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13! '5S
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.
Line 2: Total receipts.this period (page 3, line 11)
Line 3: Subtotal (line 1 plus line 2)
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Line 4: Total expenditures thisperiod (page 5, line 14)
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Line 5: Ending Balance (line 3 minus line 4)
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Line 6: Total in-kind contributions this period (page 6)
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Line 7: Total (all) outstanding liabilities (page 7)
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Line 8:
Name ofbank(s) used :I F/ fJY{/IIC<.. -'[d.Vii//Pif /!?4.1/1 k
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Amdavit of Committee Treasurer:
I certify that I have examined this report including attached schedules and it is, to the best of my kno\vledge and belief, a true and complete statement of all campaign finance
activity, including all contnbutions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represent<;. the campaign
f"mance activity of all persons acting under the of this committee in accordance with the ofM.G.L o. 55,
Signed under the penalfie.s of perjury: . (Treasurer's signature) Date:/ { /f
1
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FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: {ch_eck 1 box oni"y)
)Candidate with Committee and no activity independent of the committee -
that I have this report attached schedu.les and is, t? the best ofmy_knowledge. and belie: a true and complete stateaient_ of all campaign fi_na.nce
activity, of all persons actmg under the authonty or on behalf of this committee m accordance w1th the requrrements ofMG.L c. 55. I have notrece1ved ally contnbutiOns,
incurred any liabilities nor made any expenditures on my behalf during this reporting period.
Candidate without Committee.QR Candidate With independent activity filing separate report
0
I certify that I 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
fmance activity, including contnbutions, loaD.'l, receipts, expenditures, disbursements, in-kind contnbutions and liabilities for this reporting period and represents the
campaign fmance activity of all persons acting 7L.der the authority or on behalf of this committee in accordance with the requirements ofM.GL. c. 55.
Signed under the penalties of perjury: lh""'n /l,_L 't'. (Candidate1s signature) Date: ______ c.__l
(
SCHEDULE A: RECEIPTS
]vi 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 rec'eipts, but need only itemi!ie those receipts over $50. In addition, the
occupation and employer must be reported for all persons who contribute $200 or more in a calendar year.
(A
11
Schedule A: Receipts
11
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.)
Date Received
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Name and Residential Address
(alphabetical listing required)
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Line 9: Total Receipts over $50 (or listed above)
Line 10: Total Receipts $50 and nuder* (not listed above)
Line 11: TOTAL RECEIPTS JNTHE PERIOD
Occupation & Employer
Amount (for contribrii:ions of $200 or more)
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Enter on page 1, line 2
*If you have Itemized receipts of$50 and under, mclude them in line 9. Lme 10 should mclude only those recmpts not Itemized above.
Page 2
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SCHEDULE A: RECEIPTS (continued)
!listing
Occupation & Employer
Date Received Amount (for contributions of $200 or more)
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Line 9: Total Receipts over $50 (or listed above)
!Line 10: Total Receipts $50 aod under* (not listed above)
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I Line 11: TOTAL RECEIPTS IN THE PERI OJ)
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* If you have
s of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.
Page3
SCHEDULEA: RECEIPTS ( CVVJl!vivi'vJ
J,{. G.L. c. 55 requires that the name and residential address be repotted, in alphabetical order, for all receipts
owr $50. in a calendar year. must keep accounts and records of all receipts, but need only
wmlze those receiptS over $.50. In addition, the uc:o-upalion and employer must be reported for all persons who
tvmtrlbute $200 or more in a calendar year.
1
'hls page may be copied if additional pages are required to report all receipts. Please Include your committee name and a page
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1bef on each page
Date
Name and Residential Address Amount Occupation & Elllployer
ncceived
(alphabetical listing required) (for contributions of $200 or more)
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Total receipts in exi:css of$50 (or listed above)
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Line 9:
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. LinelO: Total receipts.$50 (not listed above) .10% ' . - ' - . . .
Line ti: TOTAL R'ECEtPTS IN TIIE PERIOD

Entir on 2 .... ..
If you have Itemized receipts of $50 and under mclude them In hne 9. Lme 10 should mclude only those rece1pts not Uenuzed
P.2
SCHEDULEB:
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.
This page may be copied if additional pages are required to report all expenditures. Please include your conunittee name and a page
nUmber on each page
Date Paid
To Whom Paid Address Purpose of Expenditure Amount
(alphabetical listing)
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Line 12: Expenditures over $50 .. ..
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Line 13: Ei<pendltures $50 and under I IJ q 08
Enter on page I, line 4 Line 14:TOTAL EXPENDITURES
14
+If you have iiemized $50 and under, include them in line 12. Line 13 should inClude only !\lose not 'C:
itemized above. Page 3
SCHEDULE C: "IN-KIND" CONTRIBUTIONS
Please itemize contributors who have made in-kind contributions of more than $50. In-kind contributions $50 and under may be
added together from the committee's records aod included in line 16 on page I.
Date Received From Whom Received* Residential Address Description of Contribution Value
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Line 15: ln-Kind Contributions over $50 (or listed above)
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Line !6: In-Kind Contributions $50 & under (not futed above) 114 . II
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Enter on.page 1, line 6 Line 17: TOTAL IN-KIND CONTRIBUTIONS
!173.tt41
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.,. If an m-kind contnbut10n IS received from a person who contnbutes more than $50 m a calendar year, you must report the name and address
of the contributor; in addition, if the contribution is $200 or more, you must also report the contributor's occupation and employer.
. Page6
SCHEDULED: LIABILITIES
MG.L. c. 55 requires committees to report ALL liabilities which have been reported previously and are still outstanding, as well
as those liabilities incurred during this reporting period.
Date Incurred To Whom Due
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Address P)lrpose Amount

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Enter on page I, line 7 __,. Line 18: TOTAL OUTSTANDING LIABILITIES (ALL)
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Page 7