barb shaughnessy financial statement - caledon · financial statement -auditor's report . and...
TRANSCRIPT
f)ht gt Ministry of Municipal Affairs Financial Statement - Auditors Report vY Ontario and Housing Form4 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 $10000 must also attach an Auditors 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 j for the conduct of the election b
yyyy yyyyMM DD
For the campaign period from (day candidate filed nomination) ~I_2_ 0___4~1_o__6~--9~1 to 2 0
[]Primary filing reflecting finances to December 31 (or 45lh day after voting day in a by-election)
D Supplementary filing including finances after December 31 (or 451h day after voting day in a by-election)
Box A Name of Candidate and Office
Candidates name as shown on the ballot Last Name
Shaughnessy Name of office for which the candidate sought election
Regional Councillor Name of Municipality
Caledon
Given Name(s)
Barbara Ward name or no (if any)
Ward I
Spending limit issued by clerk
$ 11 50590
D I did not accept any contributions or incur any expenses other than the nomination fee (Complete Box A and B only)
Box B Declaration
I Bcvv hav-et SLa - ~ f__~ssy a candidate in the municipality of
TI (( f1 06 U~c~ middot hereby declare that to the best of my knowledge and belief that these
financial statements and attach d supporting schedules are true and correct
o ~
Commissioner etc Garey Ann de~~rt~-~aof Peel while Clerk of Regional Muntcn1poafhe Town of Caledon The Corpora10
9503P (201311) copyQueens Printer for Ontario 2013 Disponible en fran9lt1is Page 1 of 10
Box C Statement of Campaign Income and Expenses
LOAN
Name of bank or recognized lending institution N A ---------------------------------~ Amount borrowed $ -----shy-shy
INCOME Total amount of all contributions (From line 1A in Schedule 1) + $ 7 85000 Refund of nomination filing fee + $ l 0000 Sign deposit refund + $ 6000 Revenue from fund-raising events not deemed a contribution (From Part Ill of Schedule 2) + $ Interest earned by campaign bank account + $ Other (provide full details)
1 +- ----shy-shy-------------shy----shy $ 2 + $ 3 + $
Total Campaign Income (Do not include loan) = $ 801000 C1
EXPENSES (Note include the value of contributions of goods and services)
Expenses subject to spending limit
Nomination filing fee + $ 10000 Inventory from previous campaign used in this campaign (list details in Table 5 of Schedule 1) + $ Advertising + $ 218026 Brochuresflyers + $ 149522 Signs (including sign deposit) + $ 192862 Meetings hosted + $ 49476 Office expenses incurred until voting day + $ 13440 Phone andor Internet expenses incurred until voting day + $ 94622 Salaries benefits honoraria professional fees incurred until voting day + $ Bank charges incurred until voting day + $ 54 11 Interest charged on loan until voting day + $ Other (provide full details)
1 Voters List + $ 1695 2 Design work (in Kind) + $ 20000 3 + $ --shy--shy--shy----shy- ------shy----shy
Tota I Expenses subject to spending limit = $ 755054 C2
Expenses not subject to spending limit Accounting and audit + $ Cost of fund-raising eventsactivities (list details in Part IV of Schedule 2) + $ Voting day partyappreciation notices + $ 120269 Office expenses incurred after voting day + $ Phone andor Internet expenses incurred after voting day + $ Salaries benefits honoraria professional fees incurred after voting day + $ Bank charges incurred after voting day + $ 1100 Interest charged on loan after voting day + $ Expenses related to recount + $ Expenses related to controverted election + $ Expenses related to compliance audit + $ Expenses related to candidates disability (provide full details)
1 +- -shy---shy--shy--shy----shy-----shy--shy $ 2 + $ 3 + $
Other (provide full details)
1 +- ---shy- --------------------shy $ 2 + $
3 + $ Total Expenses not subject to spending limit = $ 121369 C3
Total Campaign Expenses (C2 + C3) $ 876423 C4 9503P (2013111) Page 2 of10
Box o Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income - Total Expenses) (C1 - C4) + $ -75423 01 Eligible deficit carried forward by the candidate from the last election - $ 02
Total (01 shy 02) = $ -75423 If there is a surplus deduct any refund of candidates or spouses contributions to the campaign - $ Surplus (or deficit) for the campaign = $ -75423 03
If line 0 3 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 (201311) Page 3 of 10
Schedule 1 - Contributions
Part I - Summary of Contributions
Contribution from candidate (include the value of inventory listed in Table 5) + $ 75000 ~~~~~~~-
Cont rib u tion from spouse + $ ~~~~~~~-
Tot a I 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) + $ 5000
~~~~~~~-
Tot a I 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) + $ 705000
~~~~----~~-
Less Contributions returned or payable to the contributor - $ ~~~~~~~-
Cont rib u tion s paid or payable to the clerk including contributions from anonymous sources exceeding $10 - $
~~~~~~~-
TotaI Amount of Contributions (Record In Box C) = $ 785000 1A
Part II - List of Contributions from Each Single Contributor Totalling more than $100
Table 1 Monetary contributions from individuals other than candidate or spouse
Name Full Address Amount$
5160 Westney Rd Box 5036 Claremont On L I Y I A4 Elizabeth and David Currie 25000
15633 Kennedy Rd Caledon On L7C 2h7 Anthony Lawes 30000
28 Caledon Mountain Dr Grecia Mayers And David Kendall Belfountain Ont L 7K OG I 40000
Gord and Jane 16 J96 Creditview Rd Caledon Ont L 7C l Y8 Thompson 75000
Greg and Irene Aziz 16249 Creditview Road Caledon Ont LOP INO 50000
724 River Rd Belfountain Ont L7K OE5Simon and Susan Millar 20000
15583 Creditview Rd Caledon On LOP lNOBonnie Ledson 20000
Dr Ei leen Dykes 19975 Porterfield Rd Caledon On L7K l S4 10000
Colette and Butch Ferneyhough 15428 Creditview Rd Caledon On L 7C I Y7 75000
Brian Gordon 18497 Willoughby Rd Caledon On L7K IV7 75000
9503P (201311) Page 4 of 10
Name Full Address Amount$
O Additional information is listed on separate supplementary attachment Total 420000
Table 2 Monetary contributions from corporations or unions
Name (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Amount$
Accurate Appraisals Inc I 0 McCol I Dr Inglewood On L7C 3L6
Tom and Karin Bremner
Tom Bremner 50000
Competitive Advantage Incorporated
9669 Dundas St E Erin On NOB ITO
Andre Leitert Andre Leitert 50000
Pro - M Incorporated 125 Traders Blvd E Ste l Miss issauga On L472H3
Jerry Humanach Jerry Humanach 75000
Cavalier Transportation Services
14091 Humber Station Rd Bo lton On L 7E5Tl
George Ledson George Ledson 15000
856063 Ontario Ltd Fradol Farms
12 10 I Creditview Rd Tom and Donna Dolson
Tom and Donna Dolson 50000
Skyline Toronto Ltd 112 Galaxy Blvd Etobicoke On M9W 4Y6
Carol Gordon Carol Gordon 25000
O Additional information is listed on separate supplementary attachment Total 265000
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
Value$
9503P (201 311) Page 5of10
Name Full Address Description of Goods or Services
Value$
D Additional information is listed on separate supplementary attachment Total
9 503P (201311) Page 6of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10
Box C Statement of Campaign Income and Expenses
LOAN
Name of bank or recognized lending institution N A ---------------------------------~ Amount borrowed $ -----shy-shy
INCOME Total amount of all contributions (From line 1A in Schedule 1) + $ 7 85000 Refund of nomination filing fee + $ l 0000 Sign deposit refund + $ 6000 Revenue from fund-raising events not deemed a contribution (From Part Ill of Schedule 2) + $ Interest earned by campaign bank account + $ Other (provide full details)
1 +- ----shy-shy-------------shy----shy $ 2 + $ 3 + $
Total Campaign Income (Do not include loan) = $ 801000 C1
EXPENSES (Note include the value of contributions of goods and services)
Expenses subject to spending limit
Nomination filing fee + $ 10000 Inventory from previous campaign used in this campaign (list details in Table 5 of Schedule 1) + $ Advertising + $ 218026 Brochuresflyers + $ 149522 Signs (including sign deposit) + $ 192862 Meetings hosted + $ 49476 Office expenses incurred until voting day + $ 13440 Phone andor Internet expenses incurred until voting day + $ 94622 Salaries benefits honoraria professional fees incurred until voting day + $ Bank charges incurred until voting day + $ 54 11 Interest charged on loan until voting day + $ Other (provide full details)
1 Voters List + $ 1695 2 Design work (in Kind) + $ 20000 3 + $ --shy--shy--shy----shy- ------shy----shy
Tota I Expenses subject to spending limit = $ 755054 C2
Expenses not subject to spending limit Accounting and audit + $ Cost of fund-raising eventsactivities (list details in Part IV of Schedule 2) + $ Voting day partyappreciation notices + $ 120269 Office expenses incurred after voting day + $ Phone andor Internet expenses incurred after voting day + $ Salaries benefits honoraria professional fees incurred after voting day + $ Bank charges incurred after voting day + $ 1100 Interest charged on loan after voting day + $ Expenses related to recount + $ Expenses related to controverted election + $ Expenses related to compliance audit + $ Expenses related to candidates disability (provide full details)
1 +- -shy---shy--shy--shy----shy-----shy--shy $ 2 + $ 3 + $
Other (provide full details)
1 +- ---shy- --------------------shy $ 2 + $
3 + $ Total Expenses not subject to spending limit = $ 121369 C3
Total Campaign Expenses (C2 + C3) $ 876423 C4 9503P (2013111) Page 2 of10
Box o Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income - Total Expenses) (C1 - C4) + $ -75423 01 Eligible deficit carried forward by the candidate from the last election - $ 02
Total (01 shy 02) = $ -75423 If there is a surplus deduct any refund of candidates or spouses contributions to the campaign - $ Surplus (or deficit) for the campaign = $ -75423 03
If line 0 3 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 (201311) Page 3 of 10
Schedule 1 - Contributions
Part I - Summary of Contributions
Contribution from candidate (include the value of inventory listed in Table 5) + $ 75000 ~~~~~~~-
Cont rib u tion from spouse + $ ~~~~~~~-
Tot a I 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) + $ 5000
~~~~~~~-
Tot a I 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) + $ 705000
~~~~----~~-
Less Contributions returned or payable to the contributor - $ ~~~~~~~-
Cont rib u tion s paid or payable to the clerk including contributions from anonymous sources exceeding $10 - $
~~~~~~~-
TotaI Amount of Contributions (Record In Box C) = $ 785000 1A
Part II - List of Contributions from Each Single Contributor Totalling more than $100
Table 1 Monetary contributions from individuals other than candidate or spouse
Name Full Address Amount$
5160 Westney Rd Box 5036 Claremont On L I Y I A4 Elizabeth and David Currie 25000
15633 Kennedy Rd Caledon On L7C 2h7 Anthony Lawes 30000
28 Caledon Mountain Dr Grecia Mayers And David Kendall Belfountain Ont L 7K OG I 40000
Gord and Jane 16 J96 Creditview Rd Caledon Ont L 7C l Y8 Thompson 75000
Greg and Irene Aziz 16249 Creditview Road Caledon Ont LOP INO 50000
724 River Rd Belfountain Ont L7K OE5Simon and Susan Millar 20000
15583 Creditview Rd Caledon On LOP lNOBonnie Ledson 20000
Dr Ei leen Dykes 19975 Porterfield Rd Caledon On L7K l S4 10000
Colette and Butch Ferneyhough 15428 Creditview Rd Caledon On L 7C I Y7 75000
Brian Gordon 18497 Willoughby Rd Caledon On L7K IV7 75000
9503P (201311) Page 4 of 10
Name Full Address Amount$
O Additional information is listed on separate supplementary attachment Total 420000
Table 2 Monetary contributions from corporations or unions
Name (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Amount$
Accurate Appraisals Inc I 0 McCol I Dr Inglewood On L7C 3L6
Tom and Karin Bremner
Tom Bremner 50000
Competitive Advantage Incorporated
9669 Dundas St E Erin On NOB ITO
Andre Leitert Andre Leitert 50000
Pro - M Incorporated 125 Traders Blvd E Ste l Miss issauga On L472H3
Jerry Humanach Jerry Humanach 75000
Cavalier Transportation Services
14091 Humber Station Rd Bo lton On L 7E5Tl
George Ledson George Ledson 15000
856063 Ontario Ltd Fradol Farms
12 10 I Creditview Rd Tom and Donna Dolson
Tom and Donna Dolson 50000
Skyline Toronto Ltd 112 Galaxy Blvd Etobicoke On M9W 4Y6
Carol Gordon Carol Gordon 25000
O Additional information is listed on separate supplementary attachment Total 265000
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
Value$
9503P (201 311) Page 5of10
Name Full Address Description of Goods or Services
Value$
D Additional information is listed on separate supplementary attachment Total
9 503P (201311) Page 6of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10
Box o Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income - Total Expenses) (C1 - C4) + $ -75423 01 Eligible deficit carried forward by the candidate from the last election - $ 02
Total (01 shy 02) = $ -75423 If there is a surplus deduct any refund of candidates or spouses contributions to the campaign - $ Surplus (or deficit) for the campaign = $ -75423 03
If line 0 3 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 (201311) Page 3 of 10
Schedule 1 - Contributions
Part I - Summary of Contributions
Contribution from candidate (include the value of inventory listed in Table 5) + $ 75000 ~~~~~~~-
Cont rib u tion from spouse + $ ~~~~~~~-
Tot a I 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) + $ 5000
~~~~~~~-
Tot a I 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) + $ 705000
~~~~----~~-
Less Contributions returned or payable to the contributor - $ ~~~~~~~-
Cont rib u tion s paid or payable to the clerk including contributions from anonymous sources exceeding $10 - $
~~~~~~~-
TotaI Amount of Contributions (Record In Box C) = $ 785000 1A
Part II - List of Contributions from Each Single Contributor Totalling more than $100
Table 1 Monetary contributions from individuals other than candidate or spouse
Name Full Address Amount$
5160 Westney Rd Box 5036 Claremont On L I Y I A4 Elizabeth and David Currie 25000
15633 Kennedy Rd Caledon On L7C 2h7 Anthony Lawes 30000
28 Caledon Mountain Dr Grecia Mayers And David Kendall Belfountain Ont L 7K OG I 40000
Gord and Jane 16 J96 Creditview Rd Caledon Ont L 7C l Y8 Thompson 75000
Greg and Irene Aziz 16249 Creditview Road Caledon Ont LOP INO 50000
724 River Rd Belfountain Ont L7K OE5Simon and Susan Millar 20000
15583 Creditview Rd Caledon On LOP lNOBonnie Ledson 20000
Dr Ei leen Dykes 19975 Porterfield Rd Caledon On L7K l S4 10000
Colette and Butch Ferneyhough 15428 Creditview Rd Caledon On L 7C I Y7 75000
Brian Gordon 18497 Willoughby Rd Caledon On L7K IV7 75000
9503P (201311) Page 4 of 10
Name Full Address Amount$
O Additional information is listed on separate supplementary attachment Total 420000
Table 2 Monetary contributions from corporations or unions
Name (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Amount$
Accurate Appraisals Inc I 0 McCol I Dr Inglewood On L7C 3L6
Tom and Karin Bremner
Tom Bremner 50000
Competitive Advantage Incorporated
9669 Dundas St E Erin On NOB ITO
Andre Leitert Andre Leitert 50000
Pro - M Incorporated 125 Traders Blvd E Ste l Miss issauga On L472H3
Jerry Humanach Jerry Humanach 75000
Cavalier Transportation Services
14091 Humber Station Rd Bo lton On L 7E5Tl
George Ledson George Ledson 15000
856063 Ontario Ltd Fradol Farms
12 10 I Creditview Rd Tom and Donna Dolson
Tom and Donna Dolson 50000
Skyline Toronto Ltd 112 Galaxy Blvd Etobicoke On M9W 4Y6
Carol Gordon Carol Gordon 25000
O Additional information is listed on separate supplementary attachment Total 265000
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
Value$
9503P (201 311) Page 5of10
Name Full Address Description of Goods or Services
Value$
D Additional information is listed on separate supplementary attachment Total
9 503P (201311) Page 6of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10
Schedule 1 - Contributions
Part I - Summary of Contributions
Contribution from candidate (include the value of inventory listed in Table 5) + $ 75000 ~~~~~~~-
Cont rib u tion from spouse + $ ~~~~~~~-
Tot a I 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) + $ 5000
~~~~~~~-
Tot a I 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) + $ 705000
~~~~----~~-
Less Contributions returned or payable to the contributor - $ ~~~~~~~-
Cont rib u tion s paid or payable to the clerk including contributions from anonymous sources exceeding $10 - $
~~~~~~~-
TotaI Amount of Contributions (Record In Box C) = $ 785000 1A
Part II - List of Contributions from Each Single Contributor Totalling more than $100
Table 1 Monetary contributions from individuals other than candidate or spouse
Name Full Address Amount$
5160 Westney Rd Box 5036 Claremont On L I Y I A4 Elizabeth and David Currie 25000
15633 Kennedy Rd Caledon On L7C 2h7 Anthony Lawes 30000
28 Caledon Mountain Dr Grecia Mayers And David Kendall Belfountain Ont L 7K OG I 40000
Gord and Jane 16 J96 Creditview Rd Caledon Ont L 7C l Y8 Thompson 75000
Greg and Irene Aziz 16249 Creditview Road Caledon Ont LOP INO 50000
724 River Rd Belfountain Ont L7K OE5Simon and Susan Millar 20000
15583 Creditview Rd Caledon On LOP lNOBonnie Ledson 20000
Dr Ei leen Dykes 19975 Porterfield Rd Caledon On L7K l S4 10000
Colette and Butch Ferneyhough 15428 Creditview Rd Caledon On L 7C I Y7 75000
Brian Gordon 18497 Willoughby Rd Caledon On L7K IV7 75000
9503P (201311) Page 4 of 10
Name Full Address Amount$
O Additional information is listed on separate supplementary attachment Total 420000
Table 2 Monetary contributions from corporations or unions
Name (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Amount$
Accurate Appraisals Inc I 0 McCol I Dr Inglewood On L7C 3L6
Tom and Karin Bremner
Tom Bremner 50000
Competitive Advantage Incorporated
9669 Dundas St E Erin On NOB ITO
Andre Leitert Andre Leitert 50000
Pro - M Incorporated 125 Traders Blvd E Ste l Miss issauga On L472H3
Jerry Humanach Jerry Humanach 75000
Cavalier Transportation Services
14091 Humber Station Rd Bo lton On L 7E5Tl
George Ledson George Ledson 15000
856063 Ontario Ltd Fradol Farms
12 10 I Creditview Rd Tom and Donna Dolson
Tom and Donna Dolson 50000
Skyline Toronto Ltd 112 Galaxy Blvd Etobicoke On M9W 4Y6
Carol Gordon Carol Gordon 25000
O Additional information is listed on separate supplementary attachment Total 265000
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
Value$
9503P (201 311) Page 5of10
Name Full Address Description of Goods or Services
Value$
D Additional information is listed on separate supplementary attachment Total
9 503P (201311) Page 6of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
The report must be done in accordance with generally accepted auditing standards and must
set out the scope of the examination
provide an opinion as to the completeness and accuracy of the financial statement and whether it is free of material misstatement
D Report is attached
Personal information if any collected on this form is obtained under the authority of sections 78 and 95 of the Municipal Elections Act 1996 Under section 88 of the Municipal Elections Act 1996 (and despite anything in the Municipal Freedom of Information and Protection of Privacy Act) documents and materials filed with or prepared by the clerk or any other election official under the Municipal Elections Act 1996 are public records and until their destruction may be inspected by any person at the clerks office at a time when the office is open Campaign financial statements shall also be made available by the clerk in an electronic format free of charge upon request
9503P (201311) Page 10of10
Name Full Address Amount$
O Additional information is listed on separate supplementary attachment Total 420000
Table 2 Monetary contributions from corporations or unions
Name (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Amount$
Accurate Appraisals Inc I 0 McCol I Dr Inglewood On L7C 3L6
Tom and Karin Bremner
Tom Bremner 50000
Competitive Advantage Incorporated
9669 Dundas St E Erin On NOB ITO
Andre Leitert Andre Leitert 50000
Pro - M Incorporated 125 Traders Blvd E Ste l Miss issauga On L472H3
Jerry Humanach Jerry Humanach 75000
Cavalier Transportation Services
14091 Humber Station Rd Bo lton On L 7E5Tl
George Ledson George Ledson 15000
856063 Ontario Ltd Fradol Farms
12 10 I Creditview Rd Tom and Donna Dolson
Tom and Donna Dolson 50000
Skyline Toronto Ltd 112 Galaxy Blvd Etobicoke On M9W 4Y6
Carol Gordon Carol Gordon 25000
O Additional information is listed on separate supplementary attachment Total 265000
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
Value$
9503P (201 311) Page 5of10
Name Full Address Description of Goods or Services
Value$
D Additional information is listed on separate supplementary attachment Total
9 503P (201311) Page 6of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
The report must be done in accordance with generally accepted auditing standards and must
set out the scope of the examination
provide an opinion as to the completeness and accuracy of the financial statement and whether it is free of material misstatement
D Report is attached
Personal information if any collected on this form is obtained under the authority of sections 78 and 95 of the Municipal Elections Act 1996 Under section 88 of the Municipal Elections Act 1996 (and despite anything in the Municipal Freedom of Information and Protection of Privacy Act) documents and materials filed with or prepared by the clerk or any other election official under the Municipal Elections Act 1996 are public records and until their destruction may be inspected by any person at the clerks office at a time when the office is open Campaign financial statements shall also be made available by the clerk in an electronic format free of charge upon request
9503P (201311) Page 10of10
Name Full Address Description of Goods or Services
Value$
D Additional information is listed on separate supplementary attachment Total
9 503P (201311) Page 6of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
The report must be done in accordance with generally accepted auditing standards and must
set out the scope of the examination
provide an opinion as to the completeness and accuracy of the financial statement and whether it is free of material misstatement
D Report is attached
Personal information if any collected on this form is obtained under the authority of sections 78 and 95 of the Municipal Elections Act 1996 Under section 88 of the Municipal Elections Act 1996 (and despite anything in the Municipal Freedom of Information and Protection of Privacy Act) documents and materials filed with or prepared by the clerk or any other election official under the Municipal Elections Act 1996 are public records and until their destruction may be inspected by any person at the clerks office at a time when the office is open Campaign financial statements shall also be made available by the clerk in an electronic format free of charge upon request
9503P (201311) Page 10of10
Table 4 Contributions in goods or services from corporations or unions (Note must also be recorded as expenses in Box C)
Name of Corporation (Legal and Carrying on Business As)
Full Address President or Business Manager
Authorized Representative
Description of Goods or Services
Value$
Skyline Toronto Ltd l l 2 Galaxy Rd Toronto OnM9W2Y6
Carol Gordon Carol Gordon Des ign services for 2 flyers 20000
D Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part 1- Summary) $ 705000 18
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$ (yyyymmdd) Value $
9503P (201 311 ) Page 7of 10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10
Description Date Acquired (yyyymmdd)
Supplier Current Market Value $
Quantity Total Value$
D Additional information is listed on separate supplementary attachment Total
9503P (201311) Page 8 of 10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10
--------
---------- - - ----- ----------
--- --- - -
----------------
------------- - - -
------------------ - --- ------ --- ------ - ------------------- - - - - ----- ---------------- ---- --- ----- --- --------------- ------------------------ --------- -----------------
--------
Schedule 2 - Fundraising Events and Activities
Fundraising EventActivity Complete a separate schedule for each event or activity held
0 Additional schedule(s) attached
Description of fundraising evenUactivity
Date of evenUactivity (yyyymmdd) - --------------------- shy
Part 1- Ticket Revenue Admission charge (per person) (If there are a range of ticket prices attach complete breakdown of all ticket sales) + $ 2A Number of tickets sold x 2B Total Ticket Revenue (2A X 2B) (Include in Schedule 1) = $
Part II - Other revenue deemed a contribution (provide details (eg revenue from goods sold in excess of fair market value))
1 + $
2 + $
3 + $ 4 + $
5 + $
Total Part II Revenue (include in Schedule 1) = $
Part Ill - Other revenue not deemed a contribution (provide details (eg contributions of $10 or less market value of goods or services sold))
1 + $
2 + $
3 + $
4 + $
5 + $
Total Part Ill Revenue (include in Box C) = $
Part IV - Expenses related to fundraising event or activity (provide details)
+ $1 --- --- ------ - --- - - --------shy2 + $
3 + $
4 + $
5 + $
6 + $
7 + $
+ $8 --------- - ----------------shyTota I Part IV Expenses (include in Box C) = $
9503P (201311) Page 9 of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10
Auditors Report Municipal Elections Act 1996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $10000 must attach an auditors report
Professional Designation of Auditor
Municipality IDate (yyyymmdd)
Contact Information
Last Name IFirst Name ILicence Number
Address
SuiteUnit No Street No Street Name
CityTown Province Postal Code
Telephone No (including area code) Fax No Email Address
ext
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 statement and whether it is free of material misstatement
D 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 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 clerks 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 (201311) Page 10of10