I f )J [E IE ~ _ j l __ E M 102 C . F" t . . . _ , ,Form C P F : ampa1gn m a ~ e ~ 1 - K e p o r t ii i , Municipal Form U 'l JUL 2 5 _j2011:.::..J Commonwealth of Massachusetts Office of Campaign and Political Finance File with: Ci or Town Clerk or Election Commission Fill in Reporting Period dates: Beginning Date: Ending Date: j:ru.cy ~ . 1 . , ~ D i f Type ofReport: (Check one) 0 8th day preceding preliminary ~ 8 t h day preceding election 0 30 day after election 0 year-end report 0 dissolution I JCifJ.../-.( 0 t. v LEI/ f . l ~ t J I Y I lc o Ill 1'»117Te e - ro T ! t . . ~ c . r I : U ~ I ' ( I ! ! t..E V I N. $01-/ Candidate Full Name (if applicable) Committee Name· I c.rt't t : . o v ~ v i ~ ! L t vKIP- 0 3 I I FRtlNI\.. ;:L Wt?fl..f31NS'kl Office Sought and District Name of Committee Treasurer I''"' H :/ 1-/LtJ<:..- k:. ST . /t./ )fl.T H I 4 " 1 P T ! J ~ l , . 14-l 1351 Pl. C.f'\tiPNT '5T. 'PPI 13 'J. Residential Address OID60 Committee Mailing Address Telephone Number (optional): I ..f 13 ostf- 'JoJ ~ . - , I Telephone Number (optional): 11-..J / J 5 7 ~ - 3 3 - 1..{3 SUMMARY BALANCE INFORMATION: Line 1: Ending Bala nce · ront previous report Line 2: Total receipts this period (page 3, line I I) Line 3: Subtotal (line 1 plus line 2) . Line 4: Total expenditures this period (pag e 5, line 1 4 ) Li ne 5: Ending Balance (line 3 minus li ne 4) Li ne 6: Total in-kind contributions t his period (page 6) Li ne 7: Total (all) outstanding liabilities (page 7) ~ ~ ~ ~ - - ~ = = ~ ~ = = = = ~ Line 8: NrulJ.e ofbank(s) used: I FJ. 0 R(;NC/'3. S,l.l. v fll{ty1 BA 1.1 k. Affidavit of Committee Treasurer: . . , I certifY that I have examined this report including attached schedules and it is, to the best of my knowledge and bel i ef: a true and complete statement of all campaign finance activity, including all contributions, loans, receipts, expenditures, · ments, in-kind contributions and liabilities for this reporting period and represents the - campaign fmance activity of all persons acting under the autho · th · onun . in accordanc e with the r equirementsof M.G.L. c. 55 . Date: I ' 7 / ~ ' - 1 / ( ( I Candidate with Committee an d no activity i n d e p e n d ~ n t of the committee 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 finance · activity, of all persons acting under the authority or on behalf of his committee in accordance with the requirements ofM.G.L. c. 55. I have not received any contributions; 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 schedul and it is, to the best of my knowledge and belief: a t rue and complete statement of all campaign finance a ctivity, including contributions, loans, rec eipts, expendi es, ilisbursements, in-kind contributions a nd liabilities for this reporting period and represents the campaign fmance activity of all persons · g under the authori or on behalf of his committee in accordance With the requirements of M.G.L. c. 55 . Signed unde,r the penalties of perjury: I I nate: I ~ z a Y tiliJu I I I I I
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. F" t . . . _ ,Form CPF : ampa1gn m a ~ e ~ 1 - K e p o r t iii
Municipal Form U 'l JUL 2 5 _j2011:.:
Commonwealth
of Massachusetts
Office of Campaign and Political Finance .
File with: Ci or Town Clerk or Election Commissi
Fill in Reporting Period dates: Beginning Date: Ending Date: j:ru.cy ~ . 1 . , ~ D i f
Type ofReport: (Check one)
0 8th day preceding preliminary ~ 8 t h day preceding election 0 30 day after election 0 year-end report 0 dissolution
I JCifJ.../-.(0 t. v LEI/ f . l ~ t J I Y I lco Ill 1'»117Te e -ro T ! t . . ~ c . r I : U ~ I ' ( I ! ! t..EVI N.$01-/
Candidate Full Name (if applicable) Committee Name·
I c.rt't t : . o v ~ v i ~ ! L tvKIP- 0 3 I I FRtlNI\.. ;:L Wt?fl..f31NS'klOffice Sought and District · Name of Committee Treasurer
I''"'H :/1-/LtJ<:..-k:. ST. /t./ )fl.T H I 4 " 1 P T ! J ~ l , . 14-l 1351 Pl. C.f'\tiPNT '5T. 'PPI13 'J.
Residential Address O ID 6 0 Committee Mailing Address
Telephone Number (optional): I ..f13 ostf- 'JoJ ~ . - , I Telephone Number (optional): 11-..J /J 5 7 ~ - 3 3 - 1..{3
SUMMARY BALANCE INFORMATION:
Line 1: Ending Balance· ront previous report
Line 2: Total receipts this period (page 3, line II)
Line 3: Subtotal (line 1 plus line 2)
.Line 4: Total expenditures this period (page 5, line 14)
Line 5: Ending Balance (line 3 minus line 4)
Line 6: Total in-kind contributions this period (page 6)
Line 7: Total (all) outstanding liabilities (page 7)~ ~ ~ ~ - - ~ = = ~ ~ = = = = ~ Line 8: NrulJ.e ofbank(s) used: I FJ. 0 R(;NC/'3. S,l.l. v f l l { ty1 BA 1.1k.
Affidavit of Committee Treasurer: . . ,
I certifY that I have examined this report including attached schedules and it is, to the best of my knowledge and bel ief: a true and complete statement of all campaign finance
activity, including all contributions, loans, receipts, expenditures, · ments, in-kind contributions and liabilities for this reporting period and represents the -campaign
fmance activity of all persons acting under the autho · th · onun . in accordance with the r equirementsofM.G.L. c. 55 .
Date: I ' 7 / ~ ' - 1 / ( (I
Candidate with Committee and no activity i n d e p e n d ~ n t of the committee
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 finance
· activity, of all persons acting under the authority or on behalf of his committee in accordance with the requirements ofM.G.L. c. 55. I have not received any contributions;
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 repor t including attached schedul and it is, to the best of my knowledge and belief: a t rue and complete statement of all campaign
finance activity, including contributions, loans, receipts, expendi es, ilisbursements, in-kind contributions and liabilities for this reporting period and represents the
campaign fmance activity of all persons · g under the authori or on behalfof his committee in accordance With the requirements of M.G.L. c. 55 .
(alphabetical listing required) Amount (for contributions of$200 or more)
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II ICJJ.Line 9: Total Receipts over $50 (or listed a b ~ v e ) Line 10: Total Receipts $50 and under* (not listed above) I i5"0,ooJ
Line 11: TOTAL RECEIPTS IN THE PERIOD jq fCO.OO Enteronpagel, line2~ - - ~ ~ ~ ~ ~ ~ = - ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ *If you have 1tem1zed receipts of$50 and under, mclude them m line 9. Lme 10 should mclude only those recetpts not Itemized above.
SCHEDULEB: EXPENDnrrrnESlvf. G.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 ofall expenditures, but need oniy itemize those over $50. Expenditures $50 and under may be added together,
from committee records, and reported on line 13.(A "Schedule B: Ex penditures" attachment is available to complete, print and attach to this report, if addi1;ional pages are required to
report all expenditures. Please include your committee name and a page number on each page.) · - ·
To Whom Paid
Date Paid (alphabetical listing) Address Purpose of Expenditure Amount
1 ~ 1 8 / 1 1 1 ~ l ' t ~ T E P 15 .kI o<J
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Line 12:: Total Expenditures over $50 (or listed above) I -1
Line 13: Total Expenditures $50 and under* (not listed above) I IEnter on page 1, line 4 -< Line 14: TOTAL EXPENDITURES IN THE PERIOD I I
* If you have ItemiZed expenditures of $50 and under, mclude them m lme 12. Lme 13 should mclude only those expenditures not ItemiZed
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Line 12: Expenditures over $50 (or listed above) I'
Iine 13: Expenditures $50 and under* (not listed above)
Enter on page 1, line 4 -7 Line 14: TOTAL EXPENDITURES IN TH E PERIOD I* Ifyou have Itemized expendrtures of$50 and under, mclude them m !me 12. Lme 13 should mclude only those expenditures not ttemizedabove.
Date Paid (alphabetical listing) Address PurposeofExpendnure Amoun
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I j7£q8ine 12: Expenditures ~ v e r $50 (or listed above)
.1· 317,6aine l3: Expenditures $50 and under* (not listed above)
Enter on page 1. line 4 -4 Line 14: TOTAL EXPENDITTJiffiS IN THE PERIOD l1773,b* If you have Itemized expenditures of$50 and under, mclude them m !me 12. Lme 13 should mclude only those expenditures not ItemiZed
DatePa:id Vendor Name Vendor Address Purpose ofExpenditure Amou
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l II I IDl II I Dl II I Dl I I Dl .. .. "I . ' I II, Dl I II Dl I II DPage 2 Total (add to Line 1 on Page 1): I P
SCHEDULED: LIABILITIESM G.L. c. 55 requires committees to reportALL liabilities which have been reported previouslyand are still outstanding, as we
as those liabilities incurred during this reporting period.
Date Incurred ToWhomDue Address Purpose Amount
1 &/ll"l/11119- f2 " I J l. D I t . { H , q f . . l ~ e : ; e k_ S'T t... 111ft. I ,..,- :' l50oo.co.r ; 1/ 11'-} $0/1./ N t ) ! < I H t r ~ f > T z ; J . . ! t H ~ t: /'11'h?AI6-I--{
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11111" 1
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II# 1':1 (2. I f 11 'T -sr. ' ! < E ~ or- oc: f't>-6 t r
ze any reimbursements by detailing the date, payee, address, purpose and amount for each expenditure made by the person be
ursed. The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount shown
Date ofReimbursement: I 7/'ZLtt
oflndividual Being Reimbursed: I -:['()AI 7J J..I47S fVI ;tiNA(
Iep"'M' ,.,..e J" TO c ~ r : : e . r F l ~ N f ' / Z . . t . ~ f ' / A I ' S ~ i 1 - L _ ID Number (i f applicable): I I TelephoneNumber (optional): I ./ /3 I ' : J J 0 - 1 ~ ' 1 $
ITEMIZE EXPENDITURES IN EXCESS OF $50
ate Paid Vendor Name Vendor Address Purpose of Expenditure Amoun
1IoN ' P L J : l ~ M , : l ; v _ , . r I F ~ l ! < S T t:XT. f21311h/3U{l.SeM6Nf
(Include items listed on Page 2) -+ Line 1: Expenditures in excess of$50 (itemized above): 1 3oo.o.Line 2:' Expenditures $50 or under (not itemized): ILine 3: TOTAL AMOUNT REIMBURSED: l3t>O. o
The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount show
form.
Date ofReimbursement: I 7/sZ 11 A ~ l ( } ? Z ~ ( );
ividual Being Reimbursed: j /4 f?.l'-1 I E. L e P t , . . , 1 ~ / l l
I .a '11 It-? ITTE6. (tJ ( i t r ;c . r 11 Z}..( {e. '-13vi i \ /So1'/
ID Number (i f applicable): I I Telephone Number (optional): I -// J 5"7t/- " ! ~ ' i ~
ITEMIZE EXPENDITURES IN EXCESS OF $50
Date Paid Vendor Name Vendor Address Purpose of Expenditure Amou
II e o s 7 ~ oI
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(Include items listed on Page 2) -+ Line 1: Expenditures in excess of$50 (itemized above): 13'167.
Line,2: Expenditures $50 or under (not itemized): l/b3.'15
Line 3: TOTAL AMOUNT REIMBURSED: l3b>t•.
Please prepare a separate report for each reimbursement check issued by the committee.