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HomeMy WebLinkAboutCurrie, David - Initial FilingFinancia l Statement -Ontario& Mini st ry of Muni cip al Affa ir s a nd Housing Aud itor's Report Candidate -Form 4 Municipal E lections Act, 1996 (Section 88.2 5) Instructions All candidates mu st complete Boxes A and B. Candidates who receive contributions or incur expen se s must complete Boxe s C , D, Sch edule 1 a nd Schedule 2 as appropriate. Candidates who receive contributions or incur expen ses in excess of $10 ,000 must also atta ch an Auditor's Report . All surplus funds (aft er any refund to th e candidate or their spous e) s hall be immediate ly paid to th e clerk who is re s pon sibl e for the conduct of the election . YYYY MM OD YY YY MM DD Fo r t he campa ign period from (day clerk rece ived nomin at ion) I 20l. '2_ I O l::, I 29 I to r-1 :Z"""· -oz---=---==2..----+l-1-=-1-:---+1-oz.---=_,1 niti al filing refl ecting fin ances from start of c ampaign to December 31 (or 45 days after voting day in a by-e lection) □S upplem e nt a ry filin g re flecting fin ances from start of campaign to e nd of extend ed camp aign period Box A : Name of Candidate and Office Ca nd id ate's na me as shown on th e ballot Last Na me or Singl e Name c l) R / ~ Given Name (s ) DAVID W ard Name or Number (if an y) t9, Mun icip ali ty S pending Limit Contribution Limit ~e nera lc2 c)J Part ies a nd Oth er ExRress io ns of A pp rec iat io n $ c2 o'/3. 'J< Con tribu tio ns fr om Ca nd idate and Spo use $ 0 -J /. '/<I 0 1 did not accept any contributions or incur a ny expen ses . (Complete Boxes A a nd B only) Box B : Declaration beli ef th at the se fin anci al stateme nts and attach ed s upporting sch edul es are true and c orrect. Signature of Candid ate Date Filed (yyyy/m m/dd ) T im e Fil ed In it ial of Ca ndidate or Ag ent (if fi led in person ) Signature of C lerk o r Des ig nate Ju]3 oJ!i r / 0 ; '/Olltn Box C: Statement of Campa ign Income and Expe nses 9503P (2022104 ) © Quee n's Prinler for Ontario, 2022 Ois ponibl e en rran,;a is P age or • Note -No e nt ry is re qui re d . Va lues will a uto -popul ated once th e a ppli ca bl e d eta ils a re ca lculated . LOAN Name of bank or reco g ni ze d le ndin g in st itution INCOME Tota l amount of a ll contributions (from lin e 1 A in Schedu le 1) + Revenue from items $25 or less + Sign deposit refund + Revenue from fundraising events not deemed a contribution (from Part Ill of Schedu le 2) + Interest earned by campaign bank account + Other (provide fu ll details) ------------------------- ------------------------- ------------------------- ------------------------- ---------------------------=-=======- Total Campaign Income (Do not include loan) = $ $ $ + $ + $ + $ + $ + $ + $ EXPENSES (Note: Include the va lue of contributions of goods and services) 1. Expenses s ubject to general spend in g limit Inventory from previous campaig n used in this campaign (li s t details ln Tab le 2 of Schedu le 1) + $ Advertising + $ 1)0D~,qo $ 5) 1'-18 .. 'A 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 + Ba nk charges incurred until voting day+ Inte rest charged on loan until voting day + Other (provide full details) Total Expenses subject to genera l spe nding limit= $ J,~3_3:I $ $ $ 'j_oo.~ $ $ $ + $ + $ + $ + $ + $ + $ $1,681. r'I • 2. Expe nses subject t o spend ing limit for parties and other express ions of appreciation Amount borrowed $ see No te * see Note • see Note • C2 +_$ --------'■ 95 03P (2022/04) Page of Total Expenses subject to spending limit for parties and other expressions of appreciation = 3. Expenses not subject to spending limits Accounting and audit + Cost of fundraising events/activities (li st details in Part IV of Schedu le 2) + 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 to recount + Expenses related to controverted election + Expenses re lated to compliance audit + Expenses related to cand idate's disability (provide full details) Other (provide full details) ------------------------- ------------------------- ------------------------- --------------------------Tota l Expenses not subject to spend in g limits = Tota l Campaign Expenses (C2 + C3 + C4) = Box D: Calculation of Surplus or Deficit + $ + $ + $ + $ $ $ $ $ $ $ $ $ $ $ $ + $ + $ + $ + $ + $ + $ + $ + $ + $ + $ $ Excess (deficiency) of income over expenses (Income minus Tota l Expenses) (C1 -C5) + If there is a surplu s, deduct any refund of candidate's or spouse's contributions to the campa ign - + $8 }J.Jb -$ 8 {J .~b Surplus (or deficit) for the campaign = C3 see Note * C4 01 If lin e D2 shows a s urplu s, the amount must be paid in trust, at the time the financial stateme nts are filed, to the municipal clerk who is responsible for the conduct of the election. D2 9503P (2022/0<1) Page of Schedule 1 -Contributions Part I -Summary of Contribu tion s Contributions in money from candidate and spouse + Contributions in goods and services from candidate and spo use (include value listed in Table 1 and Table 2) + 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 18; list details in Table 3 and Table 4) • Include ticket revenue, contributions in money, goods and services where the total contribution from a contributor exceeds $1 00 (do not include contributions from candidate or spouse). + Less: In e ligibl e contributions paid or payable to the contributor - Contributions paid or payable to the clerk, including contributions from anonymous sources exceeding $25 - Total Amount of Contribut ion s (record under Income In Box C) = Part II -Contributions from candidate or spouse Table 1: Contributions in goods or services Descriptio n of Goods or Services see Note • $ $ see Note • $ $ $ 8 , S-00, o.:, 1A • Date Rece iv ed (yyyy/mm/dd) Tota l □Additional inform at ion is listed on separate supplementary attac hment, if completed manually. Value ($) Table 2: Inventory of campa ign goods and materials from previous municipal campaign used in this campaign (Note: Value must be recorded as a contr ibu tion from the candidate and as an expense.) Descriptio n Date Acquired Supplier (yyyy/mm/dd) C)Additional information is li sted on sep a rate supplementary attachment, if completed manually. 9503P (202V04) Quantity Current Market Value ($) Total Page of Part Ill -Contributi ons exceed i ng $100 per contributor -individuals other than candidate or spouse Table 3: Monetary contri butions from individuals other than cand id ate or spouse Name Full Address Date Received Amount (yyyy/mm/dd) Received ($) Total (]Additional information is listed on separate supplementary attachment, if completed manually . Tab le 4: Contributions in goods or services from individuals other than candidate or spouse (N ote: Must also be recorded as Expenses in Box C.} Name Full Address Description of Goods Date Received or Serv ices (yyyy/mm/dd) (JA.dditional information is listed on separate supp lementary attachment, if completed manually. Tota l for Part 111-Contributions exceeding $100 per contributor (Add tota ls from Table 3 and Table 4 and record the total in Part 1 -Summary of Contributions) 9503P (2022/04) Total Amount Returned to Contributor or Paid to C lerk {$) Value($) $ 1B ------ Page of Schedule 2 -Fundraising Events and Activities Comp lete a separate schedu le for each event or activi ty held. [)Additional schedule(s) attached, if completed manually. Fundrais in g Event/Activ ity Des cription of f un d ra is in g event/activ ity Date of eve nt/activity (yyy y/mm /d d) Part I -Ticket revenue Admission charge (per person) $ (If there are a range of ticket prices, attach complete breakdown of all ticket sales) Number of tickets sold x Total Part I (2A X 2B) (in clude in Part I of Schedule 1) = Part II -Other revenue deemed a contribution Provide details (e.g ., revenue from goods sold in excess of fair market value) + $ ------------------------- + $ ------------------------- + $ ------------------------- + $ ------------------------- + $ Total Part II (include in Part I of Schedule 1) = Part Ill -Other revenue not deemed a contribution Provide details (e.g ., contribution of $25 or less; goods or serv ic es so ld for $25 or less) + $ ------------------------- ------------------------- ------------------------- ------------------------- Tota l Part Ill (include under Income in Box C) = Part IV -Expenses related to fundraising event or activity Provide details ------------------------- ------------------------- ------------------------- ------------------------- Total Part IV Expenses (include under Expenses in Box C) = Add Event (+) 9503P (2022/04) + $ + $ + $ + $ + $ + $ + $ + $ + $ 2A 2B $ $ $ $ Remove Event (-) I Page of Auditor's Rep o rt -Municipal Elections Act, 1996 (Section 88.25) A candidate who has received contributions or incurred expenses in excess of $10,000 must attach an auditor's report. P ro fessi on al Des ig nation of Aud itor Mu nici pal ity l Date (yyyy/mm/dd ) C ontact Information Last Name or Sin gle Name Gi ven Name (s ) Address Su ite/Un it Number Street Nu mber Street Name Mun ici pa li ty Pro vi nce T e lephone Number Ema il Address The report must be done in accordance with generally accepted auditing standards and must: • set out the scope of the examination Li cence Nu mber Posta l Cod e • provide a n opinion as to the completeness and accuracy of the financial statement and whether it is free of material misstatement □Report is attached Personal info rmation, if any, collected on this form is obtained under the authority of sections 88 .25 and 95 of the Municipal E lections Act, 1996. Under section 88 of the Municipal Elections Act, 1996 (and despite anything in the Municipal Freedom of Information and Protection of Privacy Act) documents and materials filed with or prepared by the clerk or any other election official under the Municipal 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 (2022101) Page of