HomeMy WebLinkAboutKen Nash,r`�
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Ministry of Municipal �.ffairs Financial Statement - Auditor's Report
and Housing Form 4
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 campaign period from (day candidate fled nomination) I;` C�',. C� I c*"a'" ,� ,� I to ;Z�`,'f` :� ;'' � I,-: �
�` Primary filing reflecting finances to December 31 (or 45th 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)
Box A: Name of Candidate and Office
Candidate's name as shown on the ballot
Last Name
,
��1� � ���
Given Name(s)
>/L- /4�„y,, �, I yt �'� �_C..�, -r �.�i
ame of office for which the candidate sought election I Ward name or no. (if any)
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.,
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Name of Municipality
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Spe�ding limit issued by clerk
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� I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and B only)
Box B: Declaration
� - -- ..--,,: . � r q,.� .- .,�, ;a�,_�_,.,
� %�C.> Y� t. ; * LL" c a. �. j, �
, a candidate in the municipality of
C�- ;`; ��� �%C'%� ����L�'c -, �� �-'�2��,'°? , 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,.{ 1� P-t�ll a
on (yyyy/mm/dd) O���S 1 �"L� a� �i -
��-.�,�
Signature of Clerk or Commissioner
�ot5I03Io�4
Date Filed in the Clerk's O ice (yyyy/mm/dd)
�ISp DIANNE HARKER,
a Commissioner,etc.,RegianalMunicipality
of Durham, forTheCorporationofthe
Ciry ot Pickering.
Expires January 28, 2018.
` �� �--
- �� Signature of Candidate
9503P (2013/11) OO Queen's Printer for Ontario, 2013 Disponible en franr,ais Page 1 of 8
Box C: Statement of Carnpaign 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 earned by campaign bank account
Other (provide full details)
1. °
2.
3.
Total 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, 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 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 t� recount
Expenses related to controverted election
Expenses related to compliance audit
Expenses related to candidate's disability (provide full details)
1.
2.
3.
Other (provide full details)
1.
2.
3.
Total Expenses not subject to spending limit
Toial Campaign Expenses (C2 + C3)
9503P (2013H 1)
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_ � C3
_ � C4
Page 2 of 8
�• 1 • •" • • �-
Excess (deficiency) of income over expenses (Income — Total Expenses)
(C 1 — C4)
Eligibie 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
+ $
— $
_ $
— $
_ $
�
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
9503P (2013/11) Page 3 of 8
Schedule 1 - Contributions
Part I— Summary of Contributions
Contribution from candidate (include the value of inventory listed in Tabie 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 Box C)
+ $
+ $
+ $
+ $
— $
_ �
_ $
Part II — List of Contributions from Each 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
1A
Total
Amount $
9503P (2013/11) Page 4 of 8
7abie 2: hAonetary contribufiions from corp
t�ame (Legal and Carrying on Full ,4ddress
Business As)
OP UilIOP1S
PresicJent or ( Authorized
�usiness hAanager Representative
� Additionai information is listed on separate supplementary attachment
Total
Table 3: Contributions in goods or services from individuals other than candidate or spouse
(Note: must also be recorded as expenses in Box C)
Name Full Address Description of Goods
or Services
� Additional information is listed on separate supplementary attachment
Total
,Amount $
Value $
95�3P (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
Name of Corporation Full Address President or Authorized Description of Value $
(Legai and Carrying on , Business Manager Representative Goods or Services
Business As)
� Additional information is listed on separate supplementary attachment Total I
Total Part II Contributions (Add Totals from Tables 1--4) (Record in Part I— Summary) $ � B
Part ill — 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
Total
9503P (2013/11) Page 6 of 8
Schedule 2— Fundrai�ireg Events and Activi�ies
Fundraising Evenf/Activity
Complete a separate schedule for each event or activiiy held
� Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyy/mm/dd)
Part I — Ticket iievenue
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 II — Other revenue deemed a contribution
(provide details (e.g. revenue from goods sold in excess of fair market value))
1.
2.
3.
4.
5.
i'otal Part II Revenue (include in Schedule 'i)
+ $
X
+ $
+ $
+ $
+ $
+ $
Part III — Other revenue not deemed a contribution
(provide datails (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 �ox C)
Part IV — Expenses related to fundraising event or activity (provide details)
�
2.
3.
4.
5.
6.
7.
8.
Total Part IV Expenses (include in �ox C)
9503P (2013/11)
+ $
+ $
+ $
+ $
+ $
+ $
+ $
+ $
2A
2B
_ $
_ $
_ $
_ $
Page 7 of 8
Auditor's Report '
Municipal Elections Act 1996 (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 Information
Last Name
Address
Suite/Unit No. Street No
Citv�i'own
Telephone No.
Street Name
area code) I Fax No.
ext.
First Name
Province
Email Address
The report must be done in accordance with generally accepted auditing standards and must:
Date (yyyy/mm/dd)
Licence Number
Nostal C;ode
• 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,
1996. Under section 88 of the Municipal Elections Act, 1996 (and despite anything in the Municipal Freedom of /nformation and
Protection of Privacy Acfl documents and materials filed with or prepared by the clerk or any other election official under the IVlunicipal
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 also be made available by the clerk in an electronic format free of charge upon
request. •
9503P (2013/11) Page 8 of 8
09/08/ $ 100.00 '
14 '
09/Q9/ ' Minuteman Press ? $ 98.31
14
09/09/ ' $ 500.00
14 ' '
_ _ __ __ __ _ _ _ _ _ _ _
09126/ �ritannia' Printers ` $ 200.00
14
09/30/ Britannia Printers '$ 268.95 $ 567.26 '
14 '
Bank Service Charge $ 31:74
', $1, Q00.00 '
10/15 Prepaid Gredit Gard Canada $ 258.48
Post
10/16 Prepaid Credit Card Canada ' $ 495.27 ', $ 258.48 !
Post ' ' '
� 0/31 Bank Service Charge $ 33.83 $ :' 65.57
Facebook ' $ 483.89 '
Cash depasit ta close out 11:99
account Ken Nash
$1,611.99 ' $ 1,611.99 $ 632.$3 ' $ 516.96 '
__ __
__ _ _ __
__ _ _ ___ _ _
Prepaid Card Purchases ,
Ganada Post $ 245.97 '
Ganada Past $ 88.31 :
Canada Post ' � 101.00 ', $ 435.28
_ __ _ _ _
_ _ __ _
5taples $ 59.99
' ' $ 495.27 ', '
Donations I $ 40.00 '
Ken Nash $1,5i1.99