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Ontario O Ministry of Municipal Affairs Financial Statement — <br />and Housing Auditor's Report Candidate — Form 4 <br />Municipal Elections Act, 1996 (Section 88.25) <br />Instructions <br />All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses must complete <br />Boxes C, D, Schedule 1 and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in <br />excess of $10,000 must also attach an Auditor's Report. <br />All surplus funds (after any refund to the candidate or their spouse) shall be immediately paid to the clerk who is responsible <br />for the conduct of the election. <br />YYYY MM DD YYYY MM DD <br />For the campaign period from (day clerk received nomination) „�G+ �� I ��' I �� I to <br />[/itial filing reflecting finances from start of campaign to December 31 (or 45 days after voting day in a by-election) <br />Supplementary filing reflecting finances from start of campaign to end of extended campaign period <br />Box A: Name of Candidate and Office <br />Candidate's name as shown on the ballot <br />Last Name or Single Name Given Name(s) <br />D o o il. — M I LTc� j S 1 I kJ E <br />Office for Which the Candidate Sought Election Ward Name or Number (if any) <br />('_I 1Y 0Oi)A%cIL—LOil' <br />Municipality <br />Spending Limit Contribution Limit <br />General Parties and Oth Expressions of Appreciation Contributions from Candidate and Spouse <br />I did not accept any contributions or incur any expenses. (Complete Boxes A and B only) <br />Box B: Declaration <br />1, �tkktST/ nJ G Doy li " f� L� + "1 t L`Tcl declare that to the best of my knowledge and <br />belief that these financial statements and attached supporting schedules are true and correct. <br />ZoZ? vl OS <br />Si nature of Candid to Date (yyyy mm/dd) <br />Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (if filed in person) Signature of Clerk or Designate <br />9503P (2022/04) © King's Printer for Ontario, 2022. Disponible en frangais Page 1 of 7 <br />