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Home My WebLink AboutJemetio Feudjio, Jean Paulr �� r- Ontario Ministry of Municipal Affairs Financial Statement - Auditor's Report and Housing Form 4 Municipal Electrons 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 $10,000 must also attach an Auditor's 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 for the conduct of the election. YYYY MM DD YYYY MM DD For the campaign period from (day candidate filed nomination) 2 0 1 4 1 0 g 1 2 2 1 to 12 0 1 4 1 1 2 3 I ❑ ✓ Primary filing reflecting finances to December 31 (or 45'h day after voting day in a by- election) ❑ Supplementary filing including finances after December 31 (or 45th day after voting day in a by- election) Box A: Dame of Candidate and Office Candidate's name as shown on the ballot Last Name Given Name(s) .1EMET10 1"EUDJ10 JEAN PAUL Name of office for which the candidate sought election Ward name or no. (if any) Conseil Scolaire du District Catholtque Centre -Sud Region of Waterloo - Bract- Haldirnfand- Nortfolk Name of Municipality Kitchener Spending limit issued by clerk $ 7,170.05 ❑ 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, ,lean Paul Jemetio Peudjio a candidate in the municipality of Conseil Scolairc du District Catholique hereby declare that to the best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. Declared before (clerk or commissioner) in the d 1Q/1� on (yyyylmmldd) (� 2 Sign turdrd of erk or Commi sinner 0 S (03/2,6 Date Filed in the Clerk's Offic (yyyylmmldd) & —`' Si ature of Candidate 9503P (2013111) O Queen's Printer for Ontario, 2013 Disponible en franyais Page 1 of 10 Box C: Statement of Campaign Income and Expenses LOAN Name o( bank or recognized lending institution �r Amount borrowed $ ~^ INCOME Total amount of all contributions (From line iAin Schedule 1) Refund of nomination filing fee Sign deposit refund Revenue from fund-raising events not deemed m contribution (From Part III oJ Schedule 2) Interest earned by campaign bank account Other (provide full details) 2. 3. Total Campaign Income (Do not include loan) EXPENSES (Note: include the value of contributions of goods and services) Expenses subject tn spending limit Nomination fi|ingfee inventory from previous campaign used {n this campaign (list details im Table 5 of Schedule 1) Advertising Brochures/flyers Signs (including sign deposit) Meetings hosted Office expenses incurred until voting day Phone and/or Internet expenses incurred until voting day Bo|adem^ benefits, honoraria, pmhamoUnne| #*aa incurred until voting day Bank charges incurred until voting day Interest charged om loan until voting day Other (provide full details) 1. Gns (Travel multiple firnes to Kitchener, Waterloo. Cambridge 2, Brantford, Sirncoe) 3. C011ti-ibUti011 in services (Sce Table 3) Total Expenses subject to spending limit Expenses not subject to spending limit Accounting and audit Cost of fund-raising events/activities (list details in Part IV of Schedule 2) Voting day pmmtylappnacieUomnotices 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 torecount Expenses related to controverted election Expenses related to compliance audit Expenses related to candidate's disability (provide full details) 1� Kitclicnicr to 2. remove Other (provide full details) _ 1. 2 1 Total Expenses not subject to spending limit Total Campaign Expenses (C2 + C3) 9503P (2013/11) +$ *$ +� +� +$ +$ +$ = $ 1,524.25 ct +$ + +$ +$ 2 + +� +$ +� +$ +� ~ * $ 400.00 + $ 250.00 = �_1,404.25 C2 +� +� +$ +� +$ 2 *� +� +� +� +� +� +$ +� +$ ~ +� +� +� = $ 120.00 c3 = $ 1,524.2S C4 Page 2 mm Box D: Calculation of Surplus or Deficit Excess (deficiency) of income over expenses (Income - Total Expenses) (C1 - C4) $ 0.00 D1 Eligible deficit carried forward by the candidate from the last election - $ D2 Total (D1 - D2) - $ If there is a surplus, deduct any refund of candidate's or spouse's contributions to the campaign - $ Surplus (or deficit) for the campaign = $ D3 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 was responsible for the conduct of the election. Amount of $ paid to municipal clerk in the municipality of Page 3 of 14 9503P (2613!11) . . Schedule 1'Contributions part| — SmnmaryoyComtribmUoms Contribution from candidate (include the value oy inventory listed in Table 5) + $ 1,274,25 Contribution from spouse + $ Total value of contributions not exceeding $1QO per contributor ~ Include ticket revenue, contributions in money, goods and services where the total contribution from a contributor im$100or less (do not include contributions from candidate ormpouee). + $ 250.00 Total value of contributions exceeding $100 per contributor (from line 16; list details in Tables 1-4) ^ Include ticket revenue, contributions |nmoney, goods and services where the total contribution from a contributor exceeds $1O0 (do not include contributions from candidate orupuuxe). + $ ~' Less: Contributions returned urpayab|etu the contributor — $ Contributions paid or payable tn the clerk, including contributions from anonymous sources exceeding $10 — $ Tnb,U Amount of Contributions (Record in Box C) = $ L-524.25 2 1A PartU— UstniCnntribmboms from Each Single Contributor Totalling more than $1UV Table 1: Monetary contributions from individuals other than candidate or spouse Name 11 Fuill Address Amount $ �� | � P2 � � | � 9503P (2013/11) Page 4 of 10 Name I Full Address I Amount $ .-I M .1 11 92 E] Additional information is listed on separate supplementary attachment Total T kin ')• Unnafant #,nnfrihimfinnc frnm rnmorations or unions Name (Legal and Carrying on Full Address President or Authorized Amount $ Business As) or Services Business Manager Representative 48-114 Derby Street. I lannilton, ON J)oor to I)oor Flyers 50.00 L 8 W'3TS delivery .... ........ el Additional information is listed on separate supplementary attachment Total 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 Value $ or Services Rostand Tonleu Tonflick 48-114 Derby Street. I lannilton, ON J)oor to I)oor Flyers 50.00 L 8 W'3TS delivery 9503P (2013111) Page 6 of 10 Name Full Address Description of Goods Value $ or Services Joseph Bertrand Nguenio 15 Onyx Dr, I larnilton, ON Door to Door Flyers 50M L8W 4A3 delivery, Joseph Demariou 302 GleaveTerrace Milton, ON Door to Door Flyers 50.00 1-91,8111 delivery Herve Kenliefa 1712-123 (;Marlton Avenue I—ast Door to Door Flyers 50.00 I lanii1ton, ON. L8N M. delivery Pierre Firmin Tchaniani 190 Candlewood Dr., I lamilton, Door to Door Flyers 50.00 ON, L8.1 3P5 delivery el ell Additional information is listed on separate supplementary attachment Total 250.00 9503P (2013111) Page 6 of 10 Table 4: Contributions in goods or services from corporations or unions (Note: must also be recorded as expenses in Box Name of Corporation Full Address President or Authorized Description of Value $ (Legal and Carrying on Business Manager Representa tive Goods or Services Business As) el el E] Additional information is listed on separate supplementary attachment Total Total Part 11 Contributions (Add Totals from Tables 1-4) (Record in Part I — Summary) Part Ill — Inventory Tnhip 5- Inventory of CamDainn Goods and Materials from Previous Campaign used in this Campaign le e- 1B (Note: value must be recorded as a contribution from the cancociate ana is an expenbey Description Date Acquired Supplier Current Market Quantity Total Value $ (yyyy/mm/dd) Value $ 7 4n 9503P (2013/11) Description Date Acquired Supplier (yyyy/mm/dd) [:] Additional information is listed on separate supplementary attachment Current Market Quantity Value $ Total Value $ r Total Page 8 of 10 9503P (2013/11) Schedule 2 — Fundraising Events and Activities Fundraising Event/Activity Complete a separate schedule for each event or activity held n Additional schedule(s) attached Description of fundraising, eventlactivity Date of event/activity (yyyy/mmldd) Part I — 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 213 Total Ticket Revenue (2A X 2B) (include in Schedule 1) Part 11 — Other revenue deemed a contribution (provide details (e.g.. revenue from goods sold in excess of fair market value)) 1. + $ 2. + $ 3, + $ 4. + $ ...... .. ....... 5. + $ Total Part 11 Revenue (include in Schedule 1) Part III — Other revenue not deemed a contribution (provide details (e.g. contributions of $10 or less: market value of goods or services sold)) 1. + $ 2. + $ 3, + $ 4. + $ 5. + $ Total Part III Revenue (include in Box C) Part IV — Expenses related to fundraising event or activity (provide details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ 6. + $ 7. + $ 8. + $ Total Part IV Expenses (include In Box C) = $ 1� =15 9503P (2013/11) Page 9 of 10 Auditor's Report Municipal Elections Act, 1996 (Section 78) A candidate who has received contributions or incurred expenses in excess of $10,000 must attach an auditor's report. Professional Designation of Auditor r Municipality Date (yyyyimmidd) Contact Information Last Name r Address Suite /Unit No. Street No. I Street Name 11 Telephone No. (including area code) I Fax No. ext. Province Email Ac Numoer Postal Code 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 E] 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 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. Page 10 of 10 9503P (2013111)