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Home My WebLink AboutShaheen Butt�. ' � � • Ministry of t�unicipa6 Affairs FICi��C��' �t�t� �11t - ��.IC�itOr'S ��Ot� and Housing Municipal Elections Act, 1996 (Section 78) Instructions: All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses beyond the nomination fee must complete Boxes 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 clerk who was responsible for the conduct of the election. YYYY MM DD YYYY MM DD For the carr�paign period from (day candidate f6ed noenination) I � (�y! to j �'% ` i f� � l � — Primary filing reflecting finances to December 31 (or 45'h day after voting day in a by-election) ❑ Supplementary filing including finances after December 31 (or 45th day after voting day in a by-election) �ox A: Name of Candidate and t3ffice Candidate's name as shown on the ballot Last Name Name of office for which the candidate sought election � ,� � ' � �-. Name of Municipality � �. � � � � �. Spending limit is ued by clerk _ $ � t � �_ , �� Given Name(s) Ward name or no. (if any) � I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and 8 only) Box B: Declaeation ' . � �� , a candidate in the municipality of , hereby declare that to the 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 � � � -� �. �. � �` � �"�. ��-_ �_�� t�.-, ,� _ � � on (yyyy/mm/dd) �-��; � � �� . % �.�-� . � `�� °�� t�� y, g �.,.�- � .�-�. � ,� ��,�" Signature of Clerk or Commissioner '��_;�..� �a��`� �'�� r � � � � Date Filed in the Clerk's Office (yyyy/mm/dd) � �;�.� �r , . � � � � ;� � ;;. � � � ° � r r :� .. ., ,. ,, t �� . ,�r '. f m � : � . _�# ° i. '�' . :�� 4 ' 4 �.. � Signature of Candidate B503P (2013/11) O Queen's Printer for Ontario, 2013 Disponible en franrais Page 1 of 8 Box C: Sf.aternent'of Garnpaign �ncome and Expenses' ' ' ' LOAN , Name of bank or recognized lending institution �'%��i � Amount borrowed $ INCOME Total amount of al) contributions (From line 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 earned by campaign bank account Other (provide full details) � 1. 2. 3. To#al Campaign Income (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, hanoraria, professional fees incurred until voting day Bank charges incurred until voting day Interest charged on loan until voting day Other (pr vide full details) � � . , � �� ( L �✓�"%�- �%� � �7 � 2. 3. Tota( Expenses subject to spending limit Expenses not subject to spending lirnit Accounting and audit Cost of fund-raising events/activities (list details in Part IV of Schedule 2) Voting day party/appreciation notices OfFce expenses incurred after voting day Phone and/or Internet expenses incurred after voting day Salaries, benefits, 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 compliance audit Expenses refated to candidate's disability (Provide full details) 1. 2. 3. Other (provide full details) 2. 3. To�al Expenses not subject to spending fimit To#al Campaign Expenses (C2 + C3) 9503P (2�13/11) - + � �.� + $ � ,�-° + $ ,��' + $ � °�. + $ + $ + $ + $ _ � �� C1 +$�� + $ + $ ,31. + $ !� t�� r :�� ` + $ � . ' + � j�� .� + $ ,�°' + $ , + � � � r � + $ ��. + $ %��C .�. + � + $ _ $ �".�� "� � C2 + $ + � �, � � � --- + � � /.�`� � + $ + $ + $ + � � �� + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ _ $ �r � �f � C3 � _ $ � �� , C4 Page 2 of 8 �� a • • �; /_ Excess (deficiency) of income over expenses (Incame — Total Expenses) (C 1 — C4) Eligible deficit carried forward by the candidate from the last election � Total (D1 — D2) I� there is a surplus, deduct any refund of candidate's or spouse's contributions to the campaign Surplus (or deficit) for the campaign + � _ � �� CD1 — � D2 = � �.�� — $ _ � ,.� ,� e D3 If line 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 $ paid to municipal clerk in the municipality of 8503P (2013/11) Page 3 of 8 Schedule 1 - Contributions Part 1— Summary of Contributions Contribution from candidate (include the value of inventory listed in Table 5) Contribution from spouse Total value of contributions not exceeding $100 per contributor • Include ticket revenue, contributions 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 returned or payable to the contributor Contributions paid or payable to the clerk, including contributions from anonymous sources exceeding $10 Total Amount of Contributions (Record in �ox C) +� �Q�� + $ , �� 1,� x�f�. + � �-� � — $ ., �, .��1�'� -- l� Part 11— List of Contributions from �ach Single Contributor Totalling more than $100 Table 1: Monetary contributions from individuals other than candidate or spouse Name � �° e Full Address � � Adciitional information is listed on separate supplementary attachment 95�3P (2013/11) Total Amount $ Page 4 of 8 Name Full Address Amount $100 and up Receipt # Mohammed Hakim 23 Goldene Way Scarb 100.00 001 On M 1P4Y4- Waseem Mohammed 18 Reginald Lamb Cres. 500.00 002 Markham, ON Mobashir Baja 65 Chloe Cres Markhm, 100.00 003 ON Arshad and Farhat 12 Duckett Ave. 300.00 006 Chaudhary Markham ON Rahmatullah 100.00 007 Anela Jadunandan 611 Amberwood Cres 100.00 008 Pickering ON Inamullah Mirza 2318 Meriadoc Drive 200.00 009 Pickering ON Nasieer Ahmed Malik 9 Bicknell Court Ajax, ON 150.00 010 Fathi Abuzgaya 333 A Sheppard Ave 750.00 011 Pickering ON Mohammed Rahim 49 Leah Cres Ajax, ON 100.00 012 Mohammed Rahim 49 Leah Cres Ajax, ON 190.00 013 Kazim Qureshi 9 Fielding Court Ajax, ON 150.00 014 Asaad Bakbak and Haifa 37 Lyndhurst Cres. 350.00 015 Elmsallati Whitby ON Dr. Abdulmajid Ibrahim 43 Rothean Drive Whitby, 250.00 016 ON Javed and Shaheena 2 Oldfield Court Ajax, ON 100.00 017 Akbar Adnan Alawi 51 dent Street Ajax, On 100.00 020 L1t 4e9 Sohail A. Khan 1682 Major Oaks Rd 100.00 018 Pickering, ON Amira Khan and 1013 Rathmore Cres 100..00 019 Mohammed Khan Pickering, ON TOTAL �° Name Address Amount Less than $100 Receipt Ghulam Murtaza Baloch 31 Durant Cres Markham 50.00 004 ON Abid Ali 91 Summerlea Street 50.00 006 Markham, ON 100.00 I �`ab6e 2: onetary contributions from corp �arne (Legal and Carrying on Full Aciciress Business As) . . . President or I Authorized �usiness anager Representative � Additional information is listed on separate supplementary attachment Table 3: Contributions in goods or senrices from individua9s other than candidate or spouse (Note: must atso be recorded as expenses in �ox C) Total ,, � �, � Additional information is listed on separate supplementary attachment 9503P (2013/11) Page 5 of 8 Table 4: Contributions in goods or services from corporations or unions (Note: must also be recorded as expenses in Box C) Narne of Corporation Full Address President or Authorized Description of Value $ (Legal and Carrying on _ Business Manager Representative Goods or Services Business As) , � Additional information is listed on separate supplementary attachment � Total ( Total Part 11 Contributions (Add Totals from Tables 1-4) (Record in Part I— Summary) � $ ,� � Part III — Inventory Table 5: Inventory of Campaign Goods and Materials from Previous Campaign used in this Campaign ' (Note: value must be recorded as a contribution from the candidate and as an .expense) Description Date Acquired Supplier Current Market Quantity Total Value $ (yyyy/mm/dd) Value $ '� [� Additional information is listed on separate supplementary attachment B503P (2013/11) To#al �9 Page 6 of 8 - .• a •; • Fur�draising Event/�ctivity Complete a separate schedu6e for each event or activity heid � Additional schedule(s) attached Description of fundraising event/activity �� ' 1 � � 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 sales) Number of tickets sold Total Ticket Revenue (2A X 2B) (Include in Schedule 1) Part ll — Other revenue deemed a contribution (provide details (e.g. revenue from goods sold in excess of fair market value)) 1. 2. A 3. 4. 5. Total Part II Revenue (include in Schedule 1) + � ��° 2A X c�.� 2B + $ + $ + $ + $ + $ Part lll — 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 (inc9ude in Box C) Par-t IV — Expense related io fundraising event or activity (provide.de#ails) �. �� 'C� �i�� ----�. � �� - � � � 2. 3. 4. 5. � 6. 7. 8. Total Part 9V Expenses (include in �ox C) + � �� +� + $ + $ + $ + $ � + $ + $ _ $ � � _ $ _ $ �� _ $ � � -- �"� S503P (2013/11) . Page 7 of 8 Auditor's Report Municipal Electi�ns Act, ��9� {Section 78j . � : A candidate who has received contributions or incurred expenses in excess of $10,000 must attach an auditor's report. Professional Designation of Auditor Municipality Contact Information Last Name Address Suite/Unit No. I Street No. � Street Name City/Town Telephone No. (including area code) Fax No. ext. Province Email Address The report must be done in accordance with generally accepted auditing standards and must: Date (yyyy/mm/dd) Licence Number Postal Code • set out the scope of the examination • provide an opinion as to the completeness and accuracy of the financial statement and whether it is free of material misstatement � Report is attached Personal information, if any, collected on this form is obtained under the authority of sections 78 and 95 of the Municipal E/ections Act, 1996. Under section 88 of the Municipa! Elections Act, 1996 (and despite anything in the Municipal Freedom of Information and Protection of Privacy Ac� documents and materials filed with or prepared by the clerk or any other election official under the IVlunicipal Elections Act, 9996 are public records and, until their destruction, may be inspected by any person at the clerk's oifice at a time when the office is open. Campaign financial statements shall also be made available by the clerk in an electronic format free of charge upon request. (� � _�,.a 9503P (2013/11) Page 8 of 8