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Ontario O Ministry of Municipal Affairs Financial Statement — and Housing Auditor's Report Candidate — Form 4 Municipal Elections Act, 1996 (Section 88.25) Instructions All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses 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 their spouse) shall be immediately paid to the clerk who is responsible for the conduct of the election. YYYY MM DD YYYY MM DD For the campaign period from (day clerk received nomination) „�G+ �� I ��' I �� I to [/itial filing reflecting finances from start of campaign to December 31 (or 45 days after voting day in a by-election) Supplementary filing reflecting finances from start of campaign to end of extended campaign period Box A: Name of Candidate and Office Candidate's name as shown on the ballot Last Name or Single Name Given Name(s) D o o il. — M I LTc� j S 1 I kJ E Office for Which the Candidate Sought Election Ward Name or Number (if any) ('_I 1Y 0Oi)A%cIL—LOil' Municipality Spending Limit Contribution Limit General Parties and Oth Expressions of Appreciation Contributions from Candidate and Spouse I did not accept any contributions or incur any expenses. (Complete Boxes A and B only) Box B: Declaration 1, �tkktST/ nJ G Doy li " f� L� + "1 t L`Tcl declare that to the best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. ZoZ? vl OS Si nature of Candid to Date (yyyy mm/dd) Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (if filed in person) Signature of Clerk or Designate 9503P (2022/04) © King's Printer for Ontario, 2022. Disponible en frangais Page 1 of 7