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'7r'Ontario Ministry of Mun}cipal Affairs Financial Statement - Auditor's ReportCandid@te - Form 4Municipal Elections Act, 1996 (Section 88.25)

Instructions

All candidates must complete Boxes A and B. Candidatet+ who receive coritributions 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'$lO,000 must alsoattach an Auditor's Report.

All surplus funds (after any refund to the candidate or their spouse) shall be paid immediately over to the ck>rk who is responsible for theconduct of the election.

For the campaign period from (day candidate filed nomination) I,,a) -iby lo41as'itol zoiv l;2 13/ lYYYY MM DD 'm'Y MM DD

Qlnitial filing reflecting finances to December 31 (or 45 days after voting day in a by-election)

[lSupplementary filing induding finances affler December 31 (or 45 days after voting day in a by-eledion)

Box A: Name of Candidate and Office

Candidate's name as shown on the ballot

Last Name or Single Nameti i O( - ?v rt <-/'

Offlce for which the candidate sought electio-n

l Given Name(s)

Ward name or no. (if any)

rMunicipality

Spending Limit - Gene+ral

a2 a(,-Q; oL:=-" I Spending Limit - Parties and Other Expressions ofAppreciation

$ 2s'/0 (o'l[11 did not accept any contributions or incur any expenses. (Complete Boxes A and B only)

Box B: Declaration

I, .' a{ !l

, declare that to the best of my knowledge and belief that these financial

statements and attached supporting schedules are true and correct.

6 i. ( r=y

-',Ay'-

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Signature of Candidate-';z,') (; ,/ i.> 1/" C ' .'> / ?',l I(.i'

Date (yyyy/mm/dd)

Date Filed (yyyy/mm/dd) {iime Filed

20't ta&t,rr;J =2'a)l / i Mrt:? 'r:':""=!"ih;:'l?7 W

9503P(2018/04) ooueen:s,PrtflQOromario,2ota Disponible ell franpis Page 1 of 8

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Box C: Statement of Campaign Income and ExpensesLOAN

me of bank or recognized lending institution,ount borrowed 5?

INCOME

Total amount of all contributions (from Iine IA in Schedule 1 )Revenue from items $25 or less

Sign deposit refund

Revenue from fundraising events not deemed a contribution (from Part 111 ofSchedule 2)Interest earned by campaign bank accountOther (provide full details)

1.

2.

3.

4.

s.

Total Cairipaign €ncome (Do not include loan)

+$

+$

+$

+$+$

gc)

?'-i /L,/'7AX """'

,,-

+$+$

+$+$+$=$ ;C1

J0],o,aa""a 7,?2%' .X . ,P'

EXPENSES (Note: include the value of contributions of goods and services)Expenses subject to general spending limitInventory from previous campaign used in this campaign (Iist details in Table 4 ofSchedule 1)AdvertisingBrochures/flyers

Signs (including sign deposit)stings hosted

.,,t(ce expenses incurred until voting dayPhone and/or internet expenses incurred until voting daySalaries, benefits, honoraria, professional fees incurred until voting dayBank charges incurred until voting dayInterest charged on Ioan until voting dayOther (prpvide full details)(provii

Q-J1.

2-"?:a? ET?s m- ic<bh ""L4'Ts.

Total Expenses subject to general spending limit

'14?

'7' (l)l's' (--:1,l'riJ("<:'21><<('1))i%-- 'i'l-?l "iaii"

+$+$+$

+$

+$

+$

+$+$

+$

+$

+$

+$

+$

+$

+$

=$

!

i';*}i'ri' -T1(r'."> l.":r-tV 7 ;ac

]y?c<-(,2T a'72-2i so

'7 C/ .5- '-l ,Ll Z C2C'

EXPENSES

Expenses subject to spending limjt for partAgs and other expressu>ns of appreciatgoni. +$2. +$3, +$4, - - +$s, - - - - - - +$

Total Expenses subject to spending Iimtt for parties and other expressfonsnfappreciation - a - a - =$ C C3

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9503P (2018/04) Paae 2 of 8

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Expenses not sub1ect to spending limitsAccounting and audit

-qst of fundraising events/activities (Iist de.tails in Part IV of Schedule 2)fice expenses incurred after voting day

Phone and/or internet expenses incurred after voting daySalaries, benefits, honoraria, professional fees incurred after voting dayBank charges incurred after voting dayInterest charged on loan after voting dayExpenses related to recountExpenses related to controverfed electionExpenses related to complian> auditExpenses related to candidate's disability (provide full details)

1.

2.

3.

4.

s.

+$

+$

+$

+$

+$

+$+$

+$

+$

+$

+$

+$

+$

+$

+$

,eY

Other (provide full details)1.

2.

3.

4.

s.

Total Expenses not subject to spending Iimits

+$

+$

+$

+$

+$=$ C4

Total Campaign Expenses (C2 + C3 + C4) =$ qclH'l'c5Box D: Calculation of Surplus or Deficit

Excess (deficiency) of income over expenses (lncome minus Total Expenses)(C1 - C5)

Eligible deficit carried forward by the candidate from the last election(applies to 201 8 regular election only)Total (Df - D2)

If there is a surplus, deduct any refund of candidate's orspouse's contributions to the campaignSurplus (or defi6t) for the campaign

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 isresponsible for the conduct of the election.

747cE+$"l /bl.C'O o*

-$

=$(':?

76 7 0Y

7b70?-<- D3

D2

-$

=$

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M

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3chedule 1 - Contributions

)art l- Summary of Contributionsntributions in money from candidate and spouse

,ntributions in goods and services from candidate end spouseiinclude value Iisted in Table 3 and Table 4)

-otal vaiue of contributions not exceeding $100 per contributorInclude ticket revenue, contributions in money, goods and serviceswhere the total contribution from a contributor is $1 00 or less (do notiriclude contributions from carididate or spouse). +$ ,?3 i 0-

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Total value of contributions exceeding $100 per contributor (from line 1 B on page 5;1st details in Table 1 and Table 2)

Include ticket revenue, contributions in money, goods and services wherethe total contribution fron'i a contributor exceeds $1 00 (do not includecontributions from candidate or spouse).

gC

+ $ .q4 Cli? o+$

+ s 'lq 7/. "

-$Less: Contributions returned or payable to the contributorContributions paid or payable to the clerk, including contributions fromanonymous sources exceeding $25

Total Amount of Contributions (record under Income in Box C)-$

Part 11 - Contributions exceeding $100 per contributor - individuals other than candidate or spouseTable 1: Monetary contributions from individuals other than candidate or spouse

5';,ed to Contributorto Clerk

$Name

-'8 S i ? ex / i- i"y '!%

L2,,r,(tg

%.,,k)"<zs' ri

,5,,b.

Q,? x444-? m mbki O '? i

'?' A0,,i'?((,'3-

!?7< 7" Rt??. -'p? ?

Full Address Date Received Amount Rece€ved $

l ll

.-,..l l.! 117 .l,( ,- ,., ..,-S

t4" /'iy ( t' 1

l[' :} ,,,, , ) .. ,l; I- I ,,f,V, fS:ltyry,il

r 4'-.7. / . .i +'. .ir( i .4)y 5 3-, i.-,i(Q!-j't ...1(

-.,' (,, ;k" ( " 'l. ,:' l f-I,'- l( ,I.

, '<- s- ( '! f'y

" ' . c("i" )'ccl 11 .I Sl.(" , r ( r.ll(

l

{-

Table 2: Contributions in goods or services from jndividuals other than candkdate or spouse(Note: must also be recorded as Expenses }n Box C) ?

'me lvalue$%.

L i, Uq i r: Q ('ht,,A rLzx)e(or+

. -l qtAveir'st'ty5' .4,,a e % 1?

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[lAdditional information is listed on separate supplementary attachment /Q'2isp'a

Total for Part 11 - Contributions exceeding $100 per contr}butorld totals from Table 1 and Table 2 and record the total in Part 1- Summary of Contributions)

Pait 111 - Contribut}ons from candidate or spouse

Table 3: Contributions in goods or servicesl

Description of Goods or Services IValue $

s '7" ? -7/- ':)-"qn

0Additional infomiation is Iisted on separate supplementary attachment9503P (2018/041 Paah s of t

Full Address ' Description of Goodsor Services

Date Received

(yyyy/mm/dd).!

!,*:+j,i"" 7[':1 i ( (. , i (l' :" (a h

L-(l-'< al)/.-I

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'1 "' oi 'Jc .'a' a""'s" - '=(i, r.-

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b

,-'( / ('. i

l "

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l

l I

l

e)ate Reee!ved '(yyyy/mm/dd)

Table 4: Inventory of campaign goods and mater}als from previous municipal campaign used in this campa}gn(Note: value must be recorded as a contribution from the candidate and as an expense)

.scription lCurrent Market

Value $

OAdditional information is listed on separate supplementary attachment Total

A

m

lscts*rs rnrsavsihis D??? a 47 "

Date Acquired' (yyyy/mm/dd)

Supplier Quantity

l l l

ll l

Schedule 2 - Fundraising Events and Activities

Fundraising Event/Activityimplete a separate schedule for eacti event or actmity held

OAdditional schedule(s) attached

Description of fundraising event/activity

Date of event/activity (yyyy/mm/dd)

Part I- Ticket revenue

Admission charge (per person)(If there are a range of ticket prices, attach complete breakdown of all ticketsales)

Number of tickets sold

Total Partl (2A X 2B) (include in Part 1 of Schedule 1 )

x

$ 2A

2B

. s-<

Part 11 - Other revenue deemed a contribution

(e.g. revenue from goods sold in excess of fair market value)Provide details

1.

2.

3.

4.

s.

ital Part 11 (tnclude in Part 1 of Schedule 1)

Part 111 - Other revenue not deemed a contribution

(e.g. contribution of $25 or Iess; goods or services sold for $25 or Iess)Provide details

1.

2.

3.

4.

s.

Total Part 111 (include under Income in Box C)

+$

+$

+$

+$

+$

+$

+$

+$

+$

+$

7$

= ,r '

Part IV - Expenses related to fundraising event or activityProvide details

1.

2.

3.

4.

s.

6.

7.

8.

r5tal Part IV Expenses (include under Expenses in Box C)

.+$

+$

+$

+$

+$

+$

+$

+$

$-er

LDe+tub 7 hf Q

Auditor's ReportMunicjpal Elections Act, 1996 (Section 88.25)

;andidate who has received contributions or incurred experises in excess of $+1 0,000 must attach an auditor's report.' P%'o-fessional Designation of Auditor

MunicipalityDate-(-yyyy/m'?m/dd)

Contact Information

Last Name or Single NameGiven Name(s) J Licenoe Number

Address

Suite/Unit No. l Street No. l Street Name

Municipality

1 Province Postal Code

lEmail A-ddress

The report must be done in accordance with generally accepted auditing standards and must:set out the scope of the examination

provide an opinion as to the completeness and accuracy of the financial statemerit and whether it is free of materialmisstatement

Telephone No. (including area code)

[lReport is attached

M

Personal information, if any, collected on this form is obtained under the authortty of sections 88.25 and 95 of the Municipal ElectionsAct, 1996. Under section 88 of the Municipal Elections Act, 1996 (and despite anything in the Municipat Free6m of lnformabon andProtection of Privacy A<.O documents and materials filed mth or prepared by the clerk or any other election official under the Municipal'lections Act, 1 996 are public records and, until their destrumion, may be insipected by any person at the clerk's office at a time when. , a office is open. Campaign financial statements shall also be made available by the clerk in an electronic format free of charge upon'squest.

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