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Home My WebLink AboutNancy Granados�� i I Instructions: �Ainistry of flflunicipat AfFairs and Housing Finar�cial ta�e �rat - uditor`s ep�ri For 4 Municipal Elections Act, 1996 (Section 78) All candidates must complete Boxes A and B. Candidates who receive contnbutions or incur expenses beyond the nomination fee must complete �oxes C, D, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in excess of $10,000 must also attach an Auditor's Report. All surplus funds (after any refund to the candidate or his or her spouse) shall be paid immediately over to the cierk who was responsible for the conduct bf the election. YYW MM DD YYYY MM DD For the campaign period from (day candidaie filed nomination) �, � � � I � � � � io �, � � � � � � � � Primary filing reflecting finances to December 31 (or 45"' day after voting day in a by-election) ❑ Supplementary fifing including finances after December 31 (or 45th day after voting day in a by-election) Box A: Name of Candidate and Office Candidate's name as shown on the ballot Last Name ��- Name of office for which the candidate sought �, i i� ��1��,1 t�� Name of Municipality �� Spending limit issued by clerk $ ►� , 3 � . � Given Name(s) �� wartl name or no. (it any) �� I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and B only) Box B: Declaration I, � p�,y�,L �,,� ��p�,y� a� � S , a candidate in the municipality of P� G�,. P� � ytiA , hereby declare that to fhe best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. Declared before (clerk or commissioner) in the C��w 0'� P� C�C.0 � �►� v on iYYYY/mm/dd) o2L� l b / � 2 l 02�'1 IJ . �� Signature of Clerk or Commissioner �.a 1� la �.. / � , ;� � .. �r � � . �. � �r �� a � � : �' , . #. of Candidate 9503P (2013/11) OO Queen's Pnnterfor Ontano, 2013 , Disponible en fransais Page 1 of 8 Box C: 5tatemeni of Campaign lncome and Expenses LOAN ' A, / y��I Name of bank or recognized lending institution �� "� +,.,�6 �D � �� Amount borrowed $ INCOME Totai amount of aii contributions (From fine 1A in Schedule 1) Refund of nomination filing fee Sign deposit refund. Revenue from fund-raising events not deemed a contribution (From Part III of Schedule 2) Interest eamed by campaign bank account Other (provide full details) 1. 2. 3. Total Campaign Incame (Do not include loan) EXPENSES (Note:, include the value of contributions of goods and services) Expenses subject to spending limit Nomination filing fee Inventory from previous campaign used in this campaign (list details in Table 5 of Schedule 1) Advertising Brochures/flyers Signs (including sign deposit) Meetings hosted Office expenses incurred until voting day Phone and/or Internet expenses incurred until voting day Salaries, benefits, honoraria, professional fees incurred until voting day Bank charges incurred until voting day Interest charged on loan until voting day dther (provide full details) 2. 3. Total Expenses subject to spending limit Expenses not subject to spending limit Accounting and audit Cost of fund-raising events/activities (list details in Part IV of Schedule 2) Voting day party/appreciation notices Office ekpenses incurred after voting day Phone and/or Intemet expenses incurred after voting day Salaries, benefrts, honoraria, professional fees incurred after voting day Bank charges incurred after voting day Interest charged on loan after voting day Expenses related to recount Expenses related to controverted election Expenses related to compiiance audit Expenses related to candidate's disability (provide full deiails) 1. 2. 3. Other (provide full details) 1. 2. 3. Total Expereses not subject to spending limit Total Campaign E�cpenses (C2 + C3) 9503P (2013/11) + �/�� C� + � j �%ci� m �CJ + $ + $ + $ + $ + $ + $ _ $ � ��3� o�7CJ C1 + $ /�G� ° �C'° + $ + $ ��. �� + �.f. �J�rro�°. �'j�-�y + W � dr � 6 � i + $ + $ + $ + $ + � !�5 , 00 + $ + $ + � + $ _ � B d' (�"�-, Q`� c2 + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ _ $ C3 _ � 1��`�� a� ca. Page 2 of 8 Box D; Calculation af Surplus or De�icit '- Excess (deficiency) of income over expenses (Income — Total Expenses) (C1 — C4) Eligible deficit carried fonvard by the candidate from the last election Total (D1 — D2) If there is a surplus, deduct any refund of candidate's or spouse's contributions to the campaign Surplus (or deficit) for the campaign +� a"1� D1 — � C� , � t� D2 _ � ,�� ..:� — $ �� • �� _ � � a � C� D3 If fine D3 shows a surplus, the amount must be paid in trust, at the time the financial statements are filed, to the municipal clerk who was responsible for the conduct of the election. Amount of $ e� p paid to municipal clerk in the municipality of 85�3P (2013/11) Pa e 3 of 8 9 Schedule 1 - Contributions Part I— Summary of Contributions Contribution from candidate (include the value of inventory listed in Table 5) Contribufion from spouse � Total value of contributions not exceeding $100 per contributor • Include ticket revenue, contributians in money, goods and services where the total contribution from a contributor is $100 or less (do not include contributions from candidate or spouse). Total value of contributions exceeding $100 per contributor (from line 1 B; list details in Tables 1 — 4) • Include ticket revenue, contributions in money, goods and services where the total contribution from a contributor exceeds $100• (do not include contributions from candidate or spouse). Less: Contributions retumed or payable to the contributor Contributions paid or payable to the derk, including contributions from anonymous sources exceeding $10 Total Amount of Contributions (Record in Box C) + $ f�C.�Q � G��' + $ + $ /�� G� � + $ — $ — $ _ $ J��o ��i 1A Part II — List of Contributions from Each Single Contributor Totalling more than $100 8503P (2013f11) Page 4 of 8 Tabfe 2: fiAonetary contributions from corparations or unions Table 3: Contributions in goods or services from individuals other than candidate or spouse fl5�3P (20'13/11) Page 5 of 8 Tabie 4: Contributions in Name of Corporatian (Legal and Carrying on Business As) goods or services from corporations or unions (Note: must also be recordecl as expenses in Box Fuil Address President or Authorized Description of Value $ Business Manager Representative Goods or Services � Additional information is listed on separate supplementary attachment Total Part il Contributions (Add Totals from Tables 1-4) (Record in Part I- Summary) ParE Ill - Inventory Table 5: Inventory of Carnpaign Goods and Materials from Previous Campaign used in this Campaign (Note: value must be recorded as a contributian from the candidate and as an expense) Description Date Acquired Supplier Current Market Quantity (yyyy/mm/dd) Value $ � Additional information is fisted on separate supplementary attachment Total Total $ Total Value $ 16 �5�3P (2013/11) Page 6 of 8 Scf�edufe 2— Fundraising Evenfs and Activiiies Fundraising Event/Activity Comp6ete a separate schedule for each event oe aciivity hefd � Additional schedule(s) attached Description of fundraising event/activity Date of event/activity (yyyy/mm/dd) Part i — Ticket Revenue Admission charge (per person) (!f there are a range of ticket prices, attach complete breakdown of all ticket safes) + $ Number of tickets sold X Total Ticket Revenue (2A X 2B) (Include in Schedule 1) Part II — Other revenue deemed a contribution (provide details (e.g. revenue from goods sold in excess of fair market va(ue)) 1. 2. 3. 4. 5. Tota! Part 11 Revenue (include in Schedule 1) + $ + $ + $ + $ + $ Part 111— Other revenue not deemed a contribution . (provide details (e.g. contributions of $10 or less; market value of goods or services sold)) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Total Part III Revenue (include in Box C) Part IV — Expenses related to fundraising event or activity (provide details) 1. 2. 3. . 4. 5. 6. 7. 8. Total Part IV Expenses (include in Box C) + $ + $ + $ + $ + $ + $ + $ + $ 2A 2B _ $ _ .$ _ $ _ $ 3503P (2D13/11) Page 7 of 8 Auditor's Report I Municipal Elections Act, 1996 (Section 78) ; A candidate who has received contributians or incurred expenses in excess of $10,000 must attach an auditor's report. Professional Designation ofAuditor Municipality Contact Information Last Name Address ' Suite/Unit No. Street No. City/Town Telephone No. (including area code) e�. Street Name Province Fax No. � Email Address uare (yyyyimmiao� ucence Numner The report must be done in accordance with generally accepted auditing standards and must: • set out the scope of the examination • provide an opinion as to the completeness and accuracy of the financiai statement and whether it is free of material misstatement 0 Report is attached t�ode Personal information, if any, coliected on this form is obtained under the authority of sections 78 and 95 of the Municipal Elections Act, 1996. Under section 88 of the Municipal Elections Acf, 1996 (and despite anything in the Municipal Freedom oflniormafion and Protection of Privacy Acf) documents and materiais filed wifh or prepared by the clerk or any otner e►ection official under the Municipal Elecfions Acf, �996 are pubfic records and, unfil their destruction, may be inspected by any person at the clerk's office at a time when the office is open. Campaign financial statements shall afso be made available by the c{erk in an electronic format free of charge upon request. 35Q3P (2013111) Page 8 of 8