Commonwealth
of Massachusetts
Form CPF M 102-0: Campaign Finance Report
Municipal Form
Office of Campaign and Political Finance
City or Town of:
Please print or type all information, except signatures.
Beginning: Ending:
(MM/DD/YYYY) (MM/DD/YYYY)
Type of Report: (Check One)
8th day preceding preliminary/primary
8th day preceding election
30th day following election (town or special) 20th day of January (Year-End report)
Pursuant to M.G.L. Chapter 55:
1. I certify that I am a candidate for or currently hold Municipal Office.
2. I certify that I have not received any contributions, made any expenditures, or incurred any obligations during this reporting period, and do not have a campaign fund in existence.
3. I certify that I do not have a political committee.
DATE PRINT NAME
RESIDENTIAL ADDRESS
(Street and Number)
OFFICE SOUGHT
SIGNATURE
Signed under the penalties of perjury
Reporting Period:
