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Home My WebLink AboutMyrna Picotte� � �}--� r't �Ilinistry of Municipal Affairs Fl9"y�61Ct2�1 ��i�B�� Audi�or's Reporf �� a 1 1 o and Housing �orm 4 Municipal Elections Act, 1996 �Section 78) lnstructions: All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses beyand the nomination fee must complete Boxes C, D, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in excsss of $10,000 must also attach an Auditor's Report. AI[ surplus funds (after any refund to the candidate or his or her spouse) sha(I be paid immediately over to the clerk who was responsible for the conduct of the e(ection. . , YYYY MM DD YYYY MM DD'��' For �he campaign period from (day candidate fled nomination) I.,� C�-�` %;�� I�`,� I i.+ ��?_ I to ��;�}�? t°',� �;`� I�� ._� ,%'� i 1,`4 ''� Primary filing reflecting finances io Decem6er 31 (or 45th day after voting day in a by-election) ❑ Supplementary filing including financ�s after December 31 (or 45th day after voting day in a by-election) Box A: Nar�e of Candidate and O�ice : Candidate's name as shown on the ballot Last Name I Given Name(s} _ +`J: r: �� ~� � � ��s I � Name of office for which the candidate sought election Ward �� r�. d<� e or no. (if any) ' d�/ et— �' f i ~ J {.._ 1 t � �..� 1 �.. �.�_ t�' f � { e�. / � � i ' \ t � � l I � . 9 Name of Municipafity �� : �.�� `�' p � . }: . Spending limit issued by clerk ` � - ,` ;°� - � �, �- j� .' f�. L� .; �! did not accept any contributions or incur any expenses other than ihe nomination fee. (Complete Box A and 8 only) �3ox B: Dec�aration � '. , a candidate in the municipality of �;��,Gr ��a , hereby declare that to the best of my knowledge and belief that these financial statements and attached suppor�ing schedules are true and correct. � Declared before (clerk or commissioner) in the �� -... oT �� G1�-�Gt' ► V�-c� on (yyyy/mm/dd) �� 1 S f O 3 I C� �-� • �. �� Signature of C{erk or Commissioner �.o�5�a31O�i Date Filed in the Clerk's Office (yyyylmm/dd) ,�,�,�,,,_.�.. - QF��l� i�l�. ��9��.�5, �iiY �L�RK, �IT"�° iJ� �I�'J�ER��QCa, �� OFFI�I{� �f�i1��I�SiC�NE� PUi��IJ�(V� �C� ��1"R�J(� 1{27 (�F TH� C�I�ii�ll��I�NER� F�R Tfi��if�6�C �,��I�a,�,��'� ��'�': . .�a. . ._.�,a.�.�..�.�..•m- .tr-�rv� .r-�s.-+� ._._ ... = 1 : , ... _._�_. _._�- _ �_...�,-. . _..�_ � �._g- ��_._ �� Signature of Candidate �503P (2013/11) O Quepn's Printer for Ontario, 2013 Disponible en franrais Page 1 of 8 Bax �: S�aiemen� af Campaign Cncome and Expenses LOAt�I Name of bank ar recagnized fending instifution �; j�-�� ,�`- �;;�'� ��`'�� Amount borrowed $ �,,.: tt�COME . � �. Totai amount of ali eontributions (From fine 1A in Schedule 1) t$';� =: �`. �},��;�_ Refund of nomination fiiing fee +$ �'�� ,�= Sign deposit refund + $ _--�- - Revenue from fund-raising events not deemed a contribution (From Part [1l of Schedule 2) + $ --�� Interest earned by campaign bank account +$-�. Other (provide full details) � . $ � + � � �, . . � 2. + � - 3. + � , � �� Tota[ Campaign fincome (Do not include loan} _$ �� =� �.��``�. C1 EXPENSES {Note: include the value of contributions of goods and services) � Expenses subject to spending timit Namination filing fee + $ - -- fnventory from previous campaign used in this campaign (list details in Tahle 5 � of Schedule 1) + � Advertising + $ , � �r� � `/ s �� Brochures/flyers �- $��°�� -�� "`� Signs (including sign deposit) + $ � �z� �'�.�.�,,�_ G Meetings hosfed + $ � �' �w° Office expenses incurred unti( voting day +$ ��°'=� �� Phone andtor Internet expenses incurred until uating 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 futl detaits) 1. , `' _ + � 4� �.�'` .�>-�`�� _ _ ; , , �� + ,�� - 2. �. _ s . � �,, � ��`� � . � s.. _—� ''/��a`�°� 3. , .E. � Total Expenses subject to spending (imit =�$ C2 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 + $ ,� � � ,m� � s Office expenses incurred after voting day +$ �="+ � - Phone andlor lntemet expenses incurred after voting day +$ -�-. Salaries, benefits, honoraria, professional fees incurred after voting day +$ �� Bank charges incurred after voting day +$ _w Inferest cf�arged on loan after vofing day +$ ---�-� Expenses related to recount + $ -� Expenses related to controverted electian +$ -�� Expenses related to cornpliance audit +� -�.. Expenses related to candidate`s disabi[ity (provide fu[I details) 1. + $ 2. + $ 3. + $ C}ther (provide full details} 1. - + � 2. + � 3. �' � Total Expenses not subject to spending iimit =�,�E� �� %;� "� C3 7atat CamRaign Expenses (C2 + C3} =� �6 C4 9503P (2013/11) - Page 2 of 8 �� : Galculat6on of Su lus or efc6� Exce�s (defici�ncy) of income over expenses (Income — Total Expenses) (C 1 — C4) Eligibfe deficit carried for�nrard by the candidate from the last election � 1'otal (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 + $ �� — $ D2 _ $ — $ _ � 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 ele�tion. Amount of $ paid to municipaf clerk in the municipality of S503P (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 detaifs 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) + $ + $ + $ + $ — $ _ � _ � 1A Part II — L4st of Contributions from �ach Single Contributor Totalling more than $100 Table 1: Monetary contributions from individuals other than candidate or spouse Name Full Address � Additional information is listed on separate supplementary attachment Total Amount $ B503P (2013/11) Page 4 of 8 Table 2: onetary contributions frorn corporations or unions �ame (L�gal and Carrying on Fu61 Address President or Authorized Aenount $ BusinLss As) �usine�s Manager Representative � Additianal information is listed on separate supplementary attachment Total Table 3: Contributions in goods or services fr�rv� individuals other than candidat� or spouse (tdote: must also be recorded as expenses in @ox C) � Additional information is listed on separate supplementary attachment 8503P (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) Name 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 � To#al I Total Part II Contributions (Add Tpt�ls from Tables 1�4�) (Record in Part I— Summary) $ � B Part 111— Inventory Table 5: Inventory of Campaign Goods and Materials from Previous Campaign used in this Campaign (Note: value rr�ust 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 9503P (2013/11) Total Page 6 �f 8 S�h�d�le 2=�undraising Ev�nts and ctivi�o�s Funcf�ai�in� �ven�/,4c�ivity Complefe a separate schedule for each event or activity held � Additional schedule(s) attached Description of fundraising event/activity Date of event/activity (yyyy/mm/dd) Part 1— Ticbcet Revenue Admission charge (per person) (If there are a range of ticket prices, attach complete breakdown of all ticket sales) Number of tickets sold i'otal Ticket Revenue (2A X 2�) (Include in Schedu6e 1) Part ll — 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 Pa�t 61 Revenue (include in Schedule 1) + $ X + $ + $ + $ + $ + $ Part til — Other revenue not deeoned a contribution (provide details (e.g. contributions of $10 or less; market value of goods or services sold)) 1. + � 2. + � 3. + � 4. + � 5. + $ Totat Part I11 Revenue (include 6n Box C) Part IV — Expenses related to fundraising event or activity (provide details) 1. 2. 3. 4. 5. 6. 7. 8. To�ai Pae�t IV Expenses (include in �ox C) 3503P (2013/11) + $ + $ + $ + $ + $ + $ + $ + $ � _ $ _ $ _ $ _ � Page 7 of 8 Auditor`s Report , : ; Municipal Elections Act; � 996 �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 Municipafity Contact Information Last Name Addre�� Suite/Unit No. � Street No. � Street Name City�"I"own Telephe�� 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 Elections Act, 9996. Under section 88 of the Municipal Elections Act, 1996 (and despite anything in the Municipal Freedom of Information and Protection of PrivacyAcfl documents and materials filed with or prepared by the clerk or any other election'official under the Nlunicipal Elections Act, 1996 are public 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 a(so be made available by the clerk in an electronic format free of charge upon request. 9503P (2013/11) Page 8 of 8