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Home My WebLink AboutAnthony Jordan Navarro�� a � o � I�inistry o� Municipal Affaers F{P��CiCI�I �� tl� ° IEC�I��r@� �PO and Housing or 4 Municipal Elections Act, 1996 (Section 78) {restructions: All candidates must complete Boxes A and B. Candidafes whD receive contnbutions or incur expenses beyond the nominafion 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 a�y refund to the candidate or nis or her spouse) shall be paid immediately over to the clerk who was responsible for the conduct bf the election. WW MM DD YYYY MM DD For the campaign period from (day candidate filed nomination) ''ap �� ( a- ( a.- to � a{� �� Q� �..*�j �jC] Primary filing reflecting finances to December 31 (or 45"' day after voting day in a by-election) ❑ Supplementary filing inctuding finances after December 31 (or 45th day after voting day in a by�lection) : Box A'c Name of Candidate and Office Candidate's name as shown on the ballot Last Name Given Name(s) ��r�� , v��v� y Name of office for which tne candidate sought electi � � �4-y Co un e.< < ( ward name or no. (it any) � Name of Municipality `J �;�-y �� B�K��r�� Spending limit issued by clerk $ ��. � �. 3 . �a y� I did not accept any contributions or incur any expenses other than the nomination fee. (Compleie Box A and 8 only) Box B: Declaration I, ��1°ii�� b� � J��°°��°� ��a,�Gt�'�"L� , 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. Dec�ared before (clerk or commissioner) in the � C-lGt.�,t �� a� on (yyyy/mm/dd) o"t � Sig ature of Clerk or Commissioner a-�/%�63/°-�I Date Filed in the Clerks Office (yyyy/mm/dd) � � . - - ° � ... s � '� -' � �� .�� . r�i '•=��L t. =`,�� > ., r ; �� Signature of Candidate fl503P (20] 3/11) OO Queen's Printer for Ontario, 20'13 , Disponibie en fran�ais Page 1 of 8 Box C: Statement of Campaign Income and Expenses LOAN ' Name of bank or recognized lending institution Amount borrowed $ WCOME Total amount of all 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 eamed by campaign bank account Other (pravide full details) 1. 2. 3. Total Campaign Incame (Do not include loan) EXPENSES (Note:, include the value of contribufions 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 B roch u res/flyers Signs (inciuding 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 Other (provide full details) 1. 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 expenses incurred after voting day Phone and/or Intemet 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 ta controverted election Expenses related to compfiance audit Expenses related to candidate's disability (provide full details) 1. 2. 3. Other (provide full detaifs) 1. 2. 3. Totaf Experzses not subject to spending Iimit Total Campaign Expenses (C2 + C3) 35�3P (2013/11) + $ + $ + $ + $ + $ + $ + $ + $ _ $ ,j� C1 + $ � �� + $ + �$ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ _ $ l C2 + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ — + � — + � + $ + $ + $ _ � ,� C3 _ $ 1 0o C4 Page 2 of 8 �ox D: Ca6eulatian af Surp{us or Deficit - Excess (deficiency) of income over expenses (Income — Total Expenses) (C1 — C4) Eligible deficit carried forward 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 (ordeficit) forthe campaign + $ �� — $ ! b rj �2 _ $ — $ _ $ ° �C7C� 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 responsibie for the conduct of the election. . Amount of $ paid to municipal cleric in the municipality of °503P (2013/'11) Paga 3 of 8 Schedule 1 - Contributions Part I— Summary of Contribuiions Contribufion from candidaie (include the value of in�entory 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 contnbutor (from line 1 B; lisf 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 —� Contnbutions paid or payable io the clerk, induding confributions from anonymous sources exceeding $10 — � Total Amount of Contributions (Record in Box C) _� 1A Part II — List of Contributions from Each Single Contributor Totalling more ihan $100 95�3P (2013/11) Page 4 of 8 Table 3: Contributions in goods or services from individuals ofher than candidate or spouse 35�3P (2013/11) Page 5 of 8 Table 4: Contributions in Flame af Corporation (Legal and Carrying on Business As) goods or services from corporations or unions (Note: must also be recarded as expenses in Box C) Full Address President or Authorized Descriptian of Value $ Business Manager Representative Goods or Services � Additional information is listed on separate supplementary attachment iotal Part II Contributions (Add Totals from Tables 1-4) (Record in Part I— Summary) Part III — Inventory Table 5: Inventory of Carnpaign 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 Qate Acquired Supplier Current Market Quantity (yyyy/mm/dd) Value $ � Additional information is fisted on separate supplementary attachment Total I $ 16 Total Value $ Total I � 85a3P (2013/'f 1) Page 6 of 8 Schedule 2- Funafraising EvenYs ar�ci /�cgivrtbes Fundraising EventlActivity Camplete a separate schedu{e for each event or activify held � Additional schedule(s) attached Description of fundraising eventlactivity Date of event/activity (yyyy/mm/dd) Part I — Ticket Revenue Admission charge (per person} (If there are a range of ticket prices, attach complete breakdown of all ticket safes) + $ Number of tickets sold X Total Ticket Revenue (2A X 26) (include in Schedule 1) Part 11 — Other revenue deemed a contribution (provide deiails (e.g. revenue from goods sold in excess of fair market value)) 1. 2. 3. 4. 5. Totai Part II Revenue (inciude in Schedule 1) + $ + $ + $ + $ + $ Part III — 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 (indude in Box C) Part IV — Expenses related to fundraising event or ectivity (provide details) 1. 2. 3. � 4. . 5. 6. 7. 8. Total Part IV Expenses (inc(ude in Box C) + $ + $ + $ + $ + $ + $ + $ + $ 2A 2B _ $ _ $ _ $ _ $ � � � � 9503P (2013/1�) Page 7 of 8 Auditor�s Report Municipal Elections Act, 1996 (Section 78j.: A candidate who has received contributions or incurred expenses in excess of $10,000 must attach an auditors report. ProfessioRal Designation of Auditor Municipality Contact Infarmation Last Name Address � Suite/Unit No. � Street No. � Street Name City/Town Telephone No. (including area code) Fax No. ext. Province Email Address Uate (yyyy�mmidd) ucence Num�er 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 financial statement and whether it is free of material misstatement � Report is attached Personal infarmation, if any, collected on this form is obtained under the authority of sections 78 and 95 of the Municrpal Elecfions Act, 9996. Under section 88 of the Municipal Elecfions Act, 1996 (and despite anything in the Municipa! Freedom of Information arrd Profection of Privacy Act) documents and materials filed with or prepared by the clerk or any other election officiai under the Municipal. Elections Acf, 1996 are pubfic records and, until their destruction, may be inspected by any person at the clerk's office at a time when the office is open. Campaign financial sfatements shall afso be made availabfe by the clerk in an electronic format free of charge upon request. 35�3P (2013/11) Page 8 of 8