The URL can be used to link to this page

Home My WebLink AboutLisa Robinson�/'r,�-- �-- RAinistry of Municipai Affairs FII1c�ryC(�I ��t�t7y�i'!� - i!d[iOC°S �PO� f��m ' and Housing Forrn Municipal Elections Act, 1996 (Section 78) Instructions: All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses beyond the nominaiion fee must compiete �oxes C, D, Schedule 1, and Schedule 2 as appropnate. Candidates who receive contributions or incur expenses in excess of $10,000 must also attach an Auditors 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 bf the election. � YYYY MM DD�. � MM DD For the campaign period from (day candidate filed nomirtation) �, �, r� to �' �, �� `Primary filing reflecting finances to December 31 (or 45"' day after voting day in a by-election) ❑ Supplementary filing including finances after Decem6er 31 (or 45th day after voting day in a by�lection) Box A': Name of Candiciate and Office Candidate's name as shown on the ballot Last Name � Given Name(s) � � ; of�O ice for wh� the ca��f�s�g�� tion Ward name or no.�any) � � � _ �,..s 1 �°� m' �ni�A Name of � Spending limit issued by cierk °' $ � ► � � � �.�t 3 2 3 °�o � I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and 8 only) ; Box B: Declaration , hereby declare that to the best of my knowledge and belief that thesa finar�cial statements and attached supporting schedules are true and correct. SSQ3P (2013/11) OO Queen's Printerfor Ontario, 2013 . Disponibfe en franryais Page � of 8 Box C: Statement of Campaign Income and Expenses LOAN ` Name of bank or recognized lending institution Amount borrowed . $ INCOME 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 (provide full detaiis) 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 Tabie 5 ofSchedule 1) Advertising Brochures/flyers Signs (including sign deposit) Meetings hosted Office expenses incurred until voting day Phone andlor Internet expenses incurred untii voting day Salaries, benefits, honoraria, professional fees incurred until voting day Bank charges incurred uniil voting day Interest charged on loan until voting day ' Other{pr i f ta� ' ,. � ��- �� 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 andlor 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 to controverted election • Expenses related to comp{iance audit Expense elated to candidate's disabi(ity (provide full details) L 2. 3. Other (provide full details) 1. 2. 3. Total Expenses not subject to spending limit Total Campaign Expenses (C2 + C3) 3503P (2013/11) + � I �� , �� + $ � �� n �," + $ + $ + $ + $ + $ + $ _ $ � - � C1 + � � c� � : �- + $ � �� < 1 �. + �� I C� . i Z.: + � �,�,_�' � �=�� + $ + � + � + $ + $ � $ � + $ + � �� r ��a�� +� + $ =��s� �:` z + $ + $ + $ + $ + � + $ + $ + $ + $ + $ + � + $ + $ + $ + $ + $ + $ _� c3 � �� , �.�C4 Page 2 of 8 �ox D. Calculatian af Surplus or Deficit Excess (deficiency) of income over expenses (income — Total Expenses) (C1 —C4) Efigible deficit carried forward by the candidate from the last election s�� tD1- 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 + � �. D1 — $ D2 _ �_ ,� �. � — $ _ $ .. �� i� 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 fhe municipality of 95D3P (2Q13/'11) Page 3 of 8 Schedule 1 - Contributians Part I— Summary of Cantributions 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). Totai 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 totai contribution from a contributor exceeds $100 (do not include contributions from candidate or spouse). Less: Contributions retumed or payable to the contributor Contribuiions paid or payable to the derk, induding contributians from anonymous sources exceeding $10 Total Amouni of Contributions (Record in Box C) + $ + $ + $ + $ — $ — $ _ $ Part 11— List of Contributions from Each Single Contributor Totalling more than $100 T�hlo �• ne.,nptaN r-�r,trihutinns from individuals other than candidate or spouse 1A 8503P (20'I3/11) Page 4 of 8 Table 2: Monetary conYributions from corporations ar unions C�ame (Legal and Carrying on Full Address President or Authorized Business As) � ,� Business Manager Representative 7�'� t c- C.� /��.,� �Glt` C i�! I;�� -� 101�t�� Cr�� .�� °' . � � �� - � : � 1 , . � Additional information is listed on separate supplementary attachment Table 3: Contributions in goods or services from individuals other ihan candidate or spouse Total Amount $ �� 95�3P (2013/11) Page 5 of 8 Tabie 4: Contributions in goods or services from corporations or unions (Note: must also be recarded as expenses in Box Name of Corporation Full Address President or Authorized Descriptian of Value $ (Legal and Carrying on Business Manager Representative Goods or Services Business As) � Additional information is listed on separate suppiementary attachment Total Part Il 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 (yyyy/mm/dd) Value $ Z��-� � ��- I �.�,�� , �� . �� S � ?°��"�'�� i��-�� ` , � �� `�e �� _ � � �� Additional information is fisted on separate supplementary attachment Total $ 16 Total Value $ 9�� ` �� Totai 95Q3P (2013/11) Page 6 of 8 � Scheciule 2— Fundraising Events and Acfivifies Fundraising Event/Activity Complete a separate schedule for each event or activity held � Additional schedule(s) attached Description of fundraising evenf/activity � Date of event/activity (yyyy/mm/dd) ;� / Part 1— Ticket Revenue Admission charge (per person) (If there are a range of ticket prices, attach complete breakdown of all ticket sales) Number of tickefs "sold Total Ticket Revenue (2A X 2B) (Include in Schedule 1) Part I) — Other revenue deemed a contribution (provide details (e.g. revenue from goods sold in excess of fair market value)) 1. 2. 3. 4. 5. Total Part ll Revenue (include in Schedule 1) + $ X + $ + $ + $ + $ + $ 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 activity (provide details) 1. 2 3. � 4. 5. 6. 7. 8. Total Part IV Expenses (include in Box C) . + $ + $ + $ + $ + $ + $ + $ + $ 2A 2B _ $ _ $ _ $ e. _ $ 35�3P (2013/11) Page 7 of 8 !Auditor's Report ! Municipal Elections Act, 9996 (Section 78) 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 Infarmation Last Name Address Suite/Unit No. Street No. City/Town Telephone No. (including area code) ext. Street Name Fax No Province Email Address uate (yyyy�mm�aa� Numoer Postal Gotle The report must be done in accordance with generally accepted auditing standards and must: • set out the scope of the examination • provide an opiniQn 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, coflected 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 Act, 1996 (and despite anything in the Municipal Freedom of lnformafion and Protection of Privacy Act) documents and materials filed with or prepared by the clerk or any other eiection official under the Municipa( Elecfions Act, 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 statements shall afso be made available by the clerk in an electronic format free of charge upon request. ■ 9503P (2013/11) Page 8 of 8