Statement of Personal Expenditures by a Candidate

Leave This Blank:

Please Print Form and Submit Original Signed form to the Town Clerk's Office following electronic submission.
This form is for the use by a candidate who has not received any contributions, but has made expenditures of personal funds.
Detailed Report of EXPENDITURES

I certify to the best of my knowledge this Statement of Expenditures is true and correct.

Canididate's signature: _________________________________________________ Date: ___________________

NOTE: After hitting "Submit and Print", use Internet print function to print page, then MUST HIT "CONTINUE" to submit electronically.
Submit Original Signed form to Town Clerk after submitting electronically
* indicates required fields.