Form CPF M 102: Campaign Finanç~~Rcp~rt~ Municipal Form...Joshua Kussman Sep 22, 2013 2502 Buckelew Drive $500.00 Consultant, Self-employed Falls Church, VA 22046 Virginia Kussman

Form CPF M 102: Campaign Finanç~~Rcp~rt~ ~~iti~

Municipal Form OCT 28 2013Office of Campaign and Political FinaW~ ‘ S

At _C,~J

Fill in Reporting Period dates: Beginning Date: Jan 1, 2013 Endin~~~Oct~,_2013

Type of Report: (Check one)

~ 8th day preceding preliminary ~ 8th day preceding election ~ 30 day after election ~ year-end report ~ dissolution

~ Richard Alcombright Committee to Elect Alcombright

Candidate Full Name (if applicable) Committee Name

~ Mayor, City of North Adams Joanne DeRose

001cc Sought and District Name of Committee Treasurer

~ 40 Williams Street, North Adams, MA 40 Williams Street, North Adams, mA

Residential Address Committee Mailing Address

Telephone N urn her (optional): Telephone Number (optional):

SUMMARY BALANCE INFORMATION:

Line 1: Ending Balance from previous report 5,106.11~

Line 2: Total receipts this period (page 3, line 11) 15,470~

Line 3: Subtotal (line 1 plus line 2) 20,576.11~

Line 4: Total expenditures this period (page 5, line 14) 11,239.2~

Line 5: Ending Balance (line 3 minus line 4) 9,336.91~

Line 6: Total in-kind contributions this period (page 6) 0~

Line 7: Total (all) outstanding liabilities (page 7) 0~

Line 8: Name of bank(s) used: Adams Community Bank

Affidavit of Coin ni ittee Treasu rer:I certify that I have examined this report including attached schedules and it is, to the best ofmy knowledge and belief, a true and complete statement of all campaign financeactivity, including all contributions, loans, receipts, expenditures, disbursements, in—kind contributions and liabilities for this reporting period and represents the campaignfinance activity of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55.

Sigiied under the penalties of perjury: _________________________________________________________ (Treasurer’s signature) Date: - ~ 7_,ç~

FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check I box only)

/andidate with Co in in ittec and no activity independent of the coin in ittee~ I certify that I have examined this report including attached schedules and it is, to the best ofmy knowledge and belief, a true and complete statement of all campaign finance

activity, of all persons acting under the authority or on behalfof this 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 behalfduring this reporting period.

Candidate without Coin in ittec ~R Candidate with independent activity filing separate report

D l certify that I have examined this report including at ac d md it is, to the best of my knowledge and bclief~ a true and complete statement of all campaignfinance activity, including contributions, loans, rec pts, e enditures, dish~ ements, in—kind contributions and liabilities for this reporting period and represents thecampaign finance activity of all persons acting un er the i ority or on behal ofthis committee in accordance with the requirements ofM.G.L. c. 55.

Signed under the penalties of perjury: _____________________________________________________ (Candidates signature) Date: /6/e7~3

Corn rnonwealthof Massachusetts

/6’

SCHEDULE A: RECEIPTSM. 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. Co,nmittees must keep detailed accounts and records ofall receipts, but need only itemize those receipts over $50. In addition, theoccupation and employer must be reportedfor 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 toreport all receipts. Please include your committee name and a page number on each page.)

Name and Residential Address Occupation & EmployerDate Received (alphabetical listing required) Amount (for contributions of $200 or more)

Anthony AbuisiSep 2, 2013 55 Johnson Street 100

North Adams, MA 01247

Bernice AlcombrightSep 13, 2013 1547 Massachusetts Avenue 50


Bernice AlcombrightOct 1, 2013 1547 Massachusetts Avenue 25


Jun 25 2013 Bernice H Alcombright Trust 100‘ 1547 Massachusetts Avenue

Daniel AlcombrightJul 13, 2013 6154 N. Via Tres Patos 200 President & CEO, SOLON

Tucson, AZ 85750

Matthew Alcombright

Sep 18, 2013 840 Page Boulevard 100Springfield, MA 01104

~

Jane ApkinJun 18, 2013 135 Old Cheshire Road 100

Lanesboro, MA 01237

Lisa BassiAug 13, 2013 1001 Mohawk Trail 200 Realtor, Century 21 Realty


Ashley BensonOct 1, 2013 P0 Box 983 100


Berkshire County Building & Construction

Aug 21, 2013 Trade Coucil 250 Trade Union264 W. Housatonic Street

t-F~fh~Id_Mt,_fll3fl1

Lisa BlackmerJun 27, 2013 74 Cleveland Avenue 75


Gabriella BondJun 26, 2013 P0 Box 776 100 Unemployed


Line 9: Total Receipts over $50 (or listed above)

Line 10: Total Receipts $50 and under* (not listed above)

Line II: TOTAL RECEIPTS IN THE PERIOD ~ Enter on page 1, line 2

* If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.

Page 2

SCHEDULE A: RECEIPTS (continued)


Gabriella BondSep 18, 2013 P0 Box 776 100 Unemployed


Peter BreenJun 21, 2013 76 Charlene Street 100


7 Duncan BrownSep 18, 2013 P0 Box 98 250 CEO, CedarWorks

Williamstown, MA 01267

Jessica BurdickJun 27, 2013 67 Cherry Street 50


Jessica BurdickSep 11, 2013 67 Cherry Street 50


Joan CallahanSep 5, 2013 P0 Box 309 100


James CanavanJun 27, 2013 1136 Notch Road 100 Visiting Associate Professor, MCLA


James CanavanSep 18, 2013 1136 Notch Road 100 Visiting Associate Professor, MCLA


Gwendolyn CariddiOct 1, 2013 244 Church Street 100


Susan ChilsonSep 5, 2013 P0 Box 951 200 Innkeeper, The Inn on East Main Street


Sharyn CollinsSep 20, 2013 40 Orchard Hill 100


Committee to Elect Dan BianchiJun 27, 2013 6 Leroi Drive 100

Pittsfield, MA 01201

Committee to Elect Tom Bowler Sheriff

Sep 18 2013 P0 Box 643 100Pittsfield, MA 01201

~


Line 10: Total Receipts $50 and under* (not listed above) rLine 11: TOTAL RECEIPTS IN THE PERIOD ~ Enter on page 1, line 2


Page 3

Committee Name: Committee to Elect Alcombright Page:~3A

SCHEDULE A: RECEIPTSM. CL. 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 ofall receipts, but need only itemize those receipts over $50. In addition, theoccupation and employer must be reportedfor all persons who contribute $200 or more in a calendar year


William Connolly

Sep 21 2013 33 Angela Street $250.00 Tax Partner KPMG LLPCanton, MA 02021

~

Beverly CooperJun 27, 2013 424 Reservoir Road $60.00


Donna DanisApr 11, 2013 22 Demond Avenue $100.00


Eugene DelleaSep 27, 2013 26 Albany Road $100.00

West Stockbridge, MA 01266

Jun 23, 2013 $250.00 Attorney, DeRosa Dohoney LLPNorth Adams, MA 01247

John DeRosaSep 17, 2013 P0 Box 607 $250.00 Attorney, DeRosa Dohoney LLP


Donald DubendorfOct 7, 2013 P0 Box 546 $100.00


Harris ElderJul 9, 2013 84 Marion Avenue $40.00


Harris ElderSep 22, 2013 84 Marion Avenue $40.00


Nancy FitzpatrickOct 15, 2013 P0 Box 954 $500.00 President, Red Lion Inn

Stockbridge, MA 01262

Deborah ForgeaJun 27, 2013 100 Bradley Street $100.00


Trevor GilmanOct 1, 2013 45 Meade Avenue $100.00



Enter on page 1, line 2


Line 11: TOTAL RECEIPTS IN THE PERIOD


Committee Name: ~~mittee to Elect Alcombright Page: 3B



Oct 11, 2013 80 Hewitts $500.00 Professor, Williams CollegeHoosick Falls, NY 12090

Mark GoldJun 22, 2013 P0 Box 715 $100.00 Attorney, Parese Sabin Smith & Gold LLP


Mark GoldSep 18, 2013 P0 Box 715 $100.00 Attorney, Parese Sabin Smith & Gold LLP


Pamela GreenOct 1, 2013 117 Somerset Avenue $60.00


Jun 24 2013 Bruce Grinnell $100.00 Attorney Grinnell PartnersP0 Box 713\AIiIIi~r~tn~,,,, M~ fl1)~7

Sep 2 2013 Bruce Grinnell $100.00 Attorney Grinnell PartnersP0 Box 713‘A!iIn~Fn,~,n M~ PM 7~7

Sherwood GuernseyOct 1, 2013 402 Hancock Road $100.00


Gail HebertJun 27, 2013 109 Woodlawn Avenue $100.00


Patrick HernandezSep 30, 2013 206 Church Street $80.00


Janet HollandSep 5, 2013 143 Bulkley Street $100.00


Janet HollandSep 25, 2013 143 Bulkley Street $60.00

Willliamstown, MA 01267

Jun 27, 2013 485 Oblong Road $100.00 President, Berkshire Community CollegeWilliamstown, MA 01267

Ellen KennedySep 18, 2013 485 Oblong Road $100.00 President, Berkshire Community College




Line 11: TOTAL RECEIPTS IN THE PERIOD ~ Enter on page 1, line 2


Committee Name: Committee to Elect Alcombright ] Page: 3C

SCHEDULE A: RECEIPTSM 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 ofall receipts, but need only itemize those receipts over $50. In addition, theoccupation and employer must be reported for all persons who contribute $200 or more in a calendar year.


Mary Beth KennedySep 19, 2013 506 W. Main Street $150.00


Joshua KussmanSep 22, 2013 2502 Buckelew Drive $500.00 Consultant, Self-employed

Falls Church, VA 22046

Virginia KussmanSep 25, 2013 8511 Gavin Manor Court $100.00

Chevy Chase, MD 20815

Norman LaValleyJun 24, 2013 50 Veazie Street $100.00


Thomas LeavittSep 30, 2013 490 Williams Street $250.00 President, Mountain One Financial


Mary LeClairJun 27, 2013 29 Olds Street $100.00


Timothy LescarbeauJun 25, 2013 1130 Reservoir Road $100.00


Bonnie R. Lipa Revocable Trust 1999Jul 23, 2013 399 150th Avenue, Apt 1 $60.00

Madeira Beach, FL 33078

Christine MaherJul 24, 2013 34 Holly Lane $100.00


Alan MardenJun 27, 2013 568 W. Main Street $100.00


Frances MeierOct 1, 2013 12 Columbia Terrace $100.00

Adams, MA 01220

James MonteparreJun 28, 2013 100 McLain Court $100.00 Superintendent, North Adams Public Schools




Line 11: TOTAL RECEIPTS IN THE PERIOD Enter on page 1, line 2* Ifyou have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.

Committee Name: Committee to Elect Alcombright Page: 3D



James MonteparreSep 16, 2013 100 McLain Court $100.00 Superintendent, North Adams Public Schools


James MonteparreSep 23, 2013 100 McLain Court $20.00 Superintendent, North Adams Public Schools


E. John MorroccoSep 11, 2013 485 N. Houghton Street $100.00


Nancy PecorJun 27, 2013 30 Catherine Street $20.00


Nancy PecorSep 10, 2013 30 Catherine Street $50.00


Anne QuimbyJul 1, 2013 77 Charlene Street $75.00


Kathleen QuinnSep 21, 2013 115 Southworth Street $100.00


Raymond RanzoniJun 24, 2013 58 Park Avenue $100.00


Lincoln RussellOct 11, 2013 P0 Box 1061 $500.00 Photographer, Self - employed

W. Stockbridge, MA 01262

Gail SellersSep 4, 2013 243 Union Street #103 $75.00


Phillip SellersJun 27, 2013 243 Union Street #103 $50.00


Phillip SellersOct 1, 2013 243 Union Street #103 $50.00


Anthony SiracusaSep 18, 2013 681 Simonds Road $100.00




Line 11: TOTAL RECEIPTS IN THE PERIOD Enter on page 1, line 2


Committee Name: Committee to Elect Alcombright Page: 3E

SCHEDULE A: RECEIPTSM. CL. 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 ofall receipts, but need only itemize those receipts over $50. In addition, theoccupation and employer in list be reported/or all persons who contribute $200 or more in a calendar year.

Nanie and Residential Address Occupation & EmployerDate Received (alphabetical listing required) Amount (for contributions of $200 or more)

Stephen SmachettiSep 13, 2013 87 East Avenue $100.00


F. Sydney SmithersJun 19, 2013 P0 Box 188 $100.00

North Pownal, VT 05260

Robert StegemanOct 10, 2013 P0 Box 602 $500.00 Retired


Edith TaskinJun 20, 2013 79 Chestnut Street $20.00


Edith TaskinSep 28, 2013 79 Chestnut Street $40.00


Holly TaylorSep 20, 2013 231 Sweetbrook Road $100.00


Fred ThompsonSep 20, 2013 96 Maple Street $50.00


Fred ThompsonJan 11, 2013 96 Maple Street $25.00


Bette Sue WadsworthOct 10, 2013 1020 Vallejo Street $500.00 President, WLS Foundation

San Francisco, CA 94133

Christopher WadsworthOct 10, 2013 460 Bush Street Second Floor $500.00 Managing Director, Manitou Media


John WadsworthSep 10, 2013 1020 Vallejo Street $500.00 Managing Director, Morgan Stanley Asia


George WhalingSep 18, 2013 616 West Street $100.00




Line 11: TOTAL RECEIPTS IN THE PERIOD Enter on page 1, line 2* If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.

Committee Name: Committee to Elect Alcombright Page: 3F



Roberta Whitney-SmithJun 21, 2013 751 Mohawk Trail Condo lB $40.00


Roberta Whitney-SMithSep 26, 2013 751 Mohawk Trail Condo 16 $20.00


Herb WilkinsonApr 29, 2013 33 Foucher Avenue $100.00


Wayne WilkinsonJun 27, 2013 120 Oak Hill $100.00


Shirley WolfeJun 18, 2013 69 Notch Road $60.00


Line 9: Total Receipts over $50 (or listed above) $12,295.OOj

Line 10: Total Receipts $50 and under* (not listed above) $3,175.00~

Line 11: TOTAL RECEIPTS IN THE PERIOD ~ $1s,47o.0o~ ~ Enter on page 1, line 2

* Ifyou have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above.

SCHEDULE B: EXPENDITURESM 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 only itemize those over $50. Expenditures $50 and under may be added together,from cam/nit/ce records, and reported on line 13.(A “Schedule 13: Expenditures’’ attachment is available to complete, print and attach to this report, if additional pages are required toreport all expenditures. Please include your committee name and a page number on each page.)

To Whom PaidDate Paid (alphabetical listing) Address Purpose of Expenditure Amount

Fundraiser Catering 700~Amy’s Cafe P0 Box 811Sep 18, 2013 North Adams, MA 01247

~ Anthony Abuisi 55 Johnson Street Stamps, HQ Supplies, Fundraiser 27O.44~~ Oct 15, 2013 North Adams, MA 01247 Supplies [

753 5. Oaklawn PlaceJun 13, 2013 Axiom Design Group Website Hosting 125Seattle, WA 98118

121 Union Street Cards 454.74Jan 11, 2013 Beck’s Printing North Adams, MA 01247

66 Allen Street~Sep 4, 2013 Berkshire Chamber of Commerce Pittsfield, MA 01201 Advertising 100

59 Main Street~ 091/04/13 Bona Marketing North Adams, MA 01247 Advertising 325

59 Main Street~ Sep 23, 2013 Bona Marketing Stickers, Postcards, Advertising 1,151.63North Adams, MA 01247

106 Main Street~ Aug 7, 2013 Boxcar Media North Adams, MA 01247 Advertising 600

Beaver Street Rent 500[Aug 23, 2013 Cire Corporation North Adams, MA 01247

79 Cliff StreetSep 28, 2013 Dan Morgan - Photographer North Adams, MA 01247 Photographs 150

1130 5. Church StreetSep 4, 2013 Drury Football Booster Club North Adams, MA 01247 Sponsor 85

1130 5. Church Street Advertising 115Mar 28, 2013 Drury High School Yearbook North Adams, MA 01247

Enter on page 1, line 4 —~

Line 12: Total Expenditures over $50 (or listed above)

Line 13: Total Expenditures $50 and under* (not listed above)

Line 14: TOTAL EXPENDITURES IN THE PERIOD

* If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemizedabove. Page 4

SCHEDULE B: EXPENDITURES (continued)

Sep 4, 2013

Address

42 Holbrook StreetStamps


67 Main StreetMediterra Restaurant Fundraiser Cater

North Adams, MA 01 247

1 090 State Road FlowersMount Williams Greenhouses North Adams, MA 01 247

1090 State RoadMount Williams Greenhouses Flowers

North Adams, MA 01 247

North Adams Youth Basketball 206 Ashland Street SponsorLeague North Adams, MA 01 247

2211 N. First StreetJan 3, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First StreetFeb 4, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First StreetMar 4, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First StreetApr 3, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First Street~ May 3, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First Street~ Jun 3, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First Street~ Jul 3, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

2211 N. First Street~ Aug 5, 2013 PayPal Online Banking Monthly FeeSan Jose, CA 95131

Line 12: Expenditures over $50 (or listed above)

Line 13: Expenditures $50 and under* (not listed above)

Enter on page I, line 4 -, Line 14: TOTAL EXPENDITURES IN THE PERIOD* If you have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemized

above.

Lynette Ritland Bond

Page 5

Committee Name: Committee to Elect Alcombright ] Page:~5A

SCHEDULE B: EXPENDITURES

Al. G.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 in a reporting period. Connniitees must keepdetailed accounts and records ofall expenditures, but need only itemize those over $50. Expenditures $50 and under may be added together,from committee records, and reported on line 13.

To Whom Paid Purpose of Expenditure

Date Paid (aliIiabetical listing) Address (include CPF ID# ta contnbution Amountto another comm iltee~

2211 N. First StreetSep 3, 2013 PayPal San Jose, CA 95131 Online Banking Monthly Fee $30.00~

Online Banking Monthly Fee $30.00~2211 N. First Street~ 10-03/13 PayPal San Jose, CA 95131

Oct 1, 2013 Public Eat + Drink Fundraiser Cater $738.30~34 Holden StreetNorth Adams, MA 01247

Flowers $l71.55~90 Holden StreetJan 11, 2013 Quadland’s Flowers & Gifts North Adams, MA 01247

Flowers $151.2090 Holden StreetMar 14, 2013 Quadland’s Flowers & Gifts North Adams, MA 01247

Apr 8, 2013 Quadland’s Flowers & Gifts Flowers $82.6990 Holden StreetNorth Adams, MA 01247

90 Holden Street Flowers $82.69Jun 13, 2013 Quadland’s Flowers & Gifts North Adams, MA 01247

90 Holden Street~ Aug 30, 2013 Quadland’s Flowers & Gifts North Adams, MA 01247 Flowers $179.38

40 Williams Street~ Jan 11, 2013 Richard Alcombright North Adams, MA 01247 Stamps $286.70

37 Main Street~ Aug 29, 2013 Scarafoni Associates North Adams, MA 01247 Rent $800.00

85 Main Street #2~ Sep 29, 2013 The Transcript North Adams, MA 01247 Advertising $1,501.50

~ Oct 4, 2013 Time Warner Cable 225 Hodges Cross Road Advertising $275.00North Adams, MA 01247

Enter on page 1, line 4 —~

Line 12: Total Expenditures over $50 (or listed above)

Line 13: Total Expenditures $50 and under* (not listed above)

Line 14: TOTAL EXPENDITURES IN THE PERIOD

lfyou have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemized above.

SCHEDULE B: EXPENDITURES (continued)

Line 12: Expenditures over $50 (or listed above) $11,104.20

Line 13: Expenditures $50 and under* (not listed above) $135.00~

Enteron page 1, line 4 -~ Line 14: TOTAL EXPENDITURES IN THE PERIOD $11,239.20~

Committee Name: Icommittee to Elect Alcombright Page:~5B

Purpose of ExpenditureTo Whom Paid

(include CPF ID# ifa contributionDate Paid (alphabetical listing) Address ~ another committee~ Amount

Sep 16, 2013 US Postal Service Stamps $230.00~67 Summer StreetNorth Adams, MA 01247

660 Curran HighwayOct 18, 2013 WNAW-WMNB Advertising $393.00


* lfyou have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemized above.

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 beadded together from the committee’s records and included in line 16 on page 1.

Date Received From Whom Received* Residential Address Description of Contribution Value

Line 15: In-Kind Contributions over $50 (or listed above)

Line 16: In-Kind Contributions $50 & under (not listed above)

Enter on page 1, line 6 -~ Line 17: TOTAL IN-KIND CONTRIBUTIONS* If an in-kind contribution is received from a person wno contributes more than $50 in 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. Page 6

SCHEDULE D: LIABILITIESM G.L. c. 55 requires committees to report ALL liabilities which have been reportedpreviously and are still outstanding, as well

as those liabilities incurred during this reporting period.

0111cc of Campaign and Political FinanceOne Ashburton Place, Room 4)!Báston, MA 02)08(617)9794300

Form CPF R 1: Itemization of ReimbursementsOffice 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 beingreimbursed. The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount shown onthe reimbursement form. . .

. f . . . . Date of Reimbursement: —

Name of individual Being Reimbursed ~ ac~L Al

CommitteeName ~ ~

CPF ID Number (if applicable) Telephone Number (optional)

. ITEMIZE EXPENDITURES IN EXCESS OF $50 .

{ Date Paid . Vendor Name . Vendor Address Purpose of Expenditure Amount. ... . .. . . . .~.. &‘l 4t~€~ ~ * . . . .. ... . .

12u1 - I 2-. U ≤~ ~ S€1~V I N ~~an~ t-i4 o ,ztrl lz ~ 70

r.. .. ... ....

r________________

~ . (Include items listed on Page 2) —. Line 1: Expenditures in. excess of $50 (itemized above): . . [~% .7QJ

. . Line 2: Expenditures $50 or under..(not itemized):. . .~. . ~1

. . . Line 3: TOTAL AMOUNT REIMBURSED: . •. ~

Signed under the penalties of perjury:

Si~’nature of Candidate / TreasurerDate: /c ~-~5- ‘3_z_

Commonwealthof MMsachusetts

Please prepare a separate report for each reimbursement check issued by the committee.

Commonweahhof MassachUsetts

Form .CPF R 1: Itemization of ReimbursementsOffice of Campaign and Political,Finanée.

Office of Campaign and Political FinanceOne Mhburton Place, Room 41 IBàston, MA 02108(617) 979-8300

Please itemize any reimbursements by detailing the date, payee, address, purpose and amount for each expenditure made by the person beingreimbursed, The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount shown on,the reimbursemónt form. , . ‘ .

. . Date of Reimbursement: c~, — I —

Name.oflndMdua! Being Reimbursed: L~j~ ~ ~o,-~ci . .

CominitteeNarne: . ~ -k k1c~

CPF ID Number (if applicable) Telephone Number (optional)

. . . •‘ ITEMIZE EXPENDITURES IN EXCESS OF $50 . .

~ Date Paid ‘. Vendor Name’ ~. Vendor Address’ Purpose of Expenditure Amount

. :. •. ‘ ~ I., .~‘

~I2l~ U ~‘ ~ N ~4an~,fr~O12~ ~SIz2~

i___

L_

(Include items listed on Page 2) —. Line I Expenditures in excess of $50 (itemized above) £~3 I

Line 2 Expenditures $50 or under (not itemized) 1 0 1LIne 3 TOTAL AMOUNT REIMBURSED [~7t~ o~J

Signed under the penalties of perjury: , . .

: ‘ . ~ . . , Date: /O.-~2-/3, ‘ :. ‘ Signa~ureofCandidate/Treäsurer . .• . . .

Please prepare a separate report for each reimbursement check issued by the committee.

, Form .CPF R 1: Itemization of ReimbursementsOffice of Campaign and Political Finance

Cornmonweafthof Massachusetts

Office of Campaign and Political FinanceOne Ashbwton Place, Room 41 IBásaon,MAO2IO8 V

(617) 979-8300 V V

Please itemize any reimbursements by detailing the date, payee, address, purpose and amount for each expenditure made by the person beingreimbursed. The total amount reimbursed to the individual (which must be by committee check) should be the same as the amount shown onthe reimbursemónt form. V

I Date of Reimbursement: ~

Name of Individual Being Reimbursed ~ A,. k, ~- ‘ si

CommitteeNarne: V W.e~ -[~ EA.~L~ A (C~i1 V

CPF ID Number (if applicable): V V V V Telephone Number (optional): V V

ITEMIZE EXPENDITURES IN EXCESS OF $50

• Date Paid Vendor Name V Vendor Address Purpose of Expenditure. Amount

~ V V V : V V~• V VV 7~ Mt~üi V V ~~-14r~r V V

t~(~-1~j3 Vtn~ ~ \Iit~4~’s ,‘J ~ Mn 012J47 ~rt~e~ ~IZ~ (01

V V ~ .~ V V

q3~13 ~ p~4~-( c&v~ ~ Ot2~ ~

if___ F___ ——

[_ .~ V.

(Include items listed on Page 2) —. Line 1 Expenditures in excess of $50 (itemized above) [ ,1471 (ol JV V V Line 2:. Expenditures $50 or under~(not itemized): V V V V V ~

Line 3 TOTAL AMOUNT REIMBURSED [~3o qqj

Signed under the penalties of perjury: V

• . V ~~ V V V Date:Sidfiature of Candidate / Treasurer

Please prepare a separate report for each reimbursement öheck issuedby the committee.

Documents

Form CPF M 102: Campaign Finanç~~Rcp~rt~ Municipal Form...Joshua Kussman Sep 22, 2013 2502 Buckelew Drive $500.00 Consultant, Self-employed Falls Church, VA 22046 Virginia Kussman