Form Center

2. A candidate's committee must be registered with the Town Clerk prior to receiving contributions or having expenditures. Committee registration requires a separate bank account be established. All contributions, expenditures and loans must be reported.
4. Committee Name*
5. Registered Agent or Candidate Name*
7. Registered Agent or Candidate Telephone*
8. Registered Agent or Candidate Email*
9. Committee Bank Name *
11. Type of Filing*
    -- Select One --Regular scheduled filingAmended reportTermination report
12. If Amended Report, indicate date of original filing
14. Reporting Period*
    -- Select One --Period 1Period 2
16. Beginning Balance*
17. Contributions Received*
18. Expenditures*
19. Ending Balance*
21. CONTRIBUTIONS
23. Date*
24. Amount*
25. Name of Contributor #1*
27. Address*
28. City*
29. State*
30. Zip Code
32. Date
33. Amount
34. Name of Contributor #2
36. Address
37. City
38. State
39. Zip Code
41. Date
42. Amount
43. Name of Contributor #3
45. Address
46. City
47. State
48. Zip Code
50. Date
51. Amount
52. Name of Contributor #4
54. Address
55. City
56. State
57. Zip Code
59. Date
60. Amount
61. Name of Contributor #5
63. Address
64. City
65. State
66. Zip Code
68. EXPENDITURES
70. Date
71. Amount*
72. Business Name #1*
74. Purpose*
76. Date
77. Amount
78. Business Name #2
80. Purpose
82. Date
83. Amount
84. Business Name #3
86. Purpose
88. Date
89. Amount
90. Business Name #4
92. Purpose
94. CONTRIBUTIONS IN KIND
96. Date*
97. Estimated Value*
98. Received From*
100. Address
101. City*
102. State*
103. Zip Code*
105. Type of Contribution*
107. Date
108. Estimated Value
109. Received From
111. Address
112. City
113. State
114. Zip Code
116. Type of Contribution
118. LOANS
120. Date*
121. Amount*
122. Received From*
124. Address*
125. City *
126. State*
127. Zip Code
129. Purpose of Loan
131. Date
132. Amount
133. Received From
135. Address
136. City
137. State
138. Zip Code
140. Purpose of Loan
Leave This Blank:


142. 1. Receive an email copy of this form.
143. Email address

     This field is not part of the form submission.

144. Submit Submit and Print

* indicates a required field