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t,,` Ontario U�� mnuHou�om Statement ~
Form 4
Municipal Elections Act, YQ0O (Section 70
Instructions:
All candidates must complete Boxes A and 8. Candidates who receive cortributimnsmrincur expenses beyond the nomination fee
must complete Boxes C, D, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses |n
excess mf$10,000 must also attach anAuditor'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 DID
For the campaign period from (day candidate filed nomination) to 2014 10 _j 14
Primary 0ing reflecting finances to December 31 (or 45 th day after voting day in a by-election)
F] supplementary filing including finances after December 31 (or 45 1h day after voting day in a by-election)
Box A: Name of Candidate and Office
Candidate's name a*shown on the ballot
Last Name Given Name(s)
James Rhodes
Name of office for which the candidate sought election Ward name or no. (if any)
Mayor
Name of Municipality
City ofKitchener
Spending limit issued by clerk
slA6,5V1.35
I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and B only)
Box B:Declaration
h. James Rhodes .0 candidate in the municipality o[
City of Kitchener .hereby declare that io the best wfnny knowledge and belief that these
financial statements and attached supporting schedules are true and correct.
Beobmd commissioner)
in the
Signature of Clerk or Commissioner
Date Filed in the berk's Office (yyyy/mm/dd)
)Siatle o�f�Candidate
9503p(2013/11) woveoo's Printer for Ontario, 2013 ois^oowwwnoaingais Page 1 wu
box C: Statement of Campaign Income and Expenses
+
. -.. - --
$
LOAN!
=
_..m._�
$ 5,329.39 C2
Name of bank or recognized lending institution
Amount borrowed 0.00
+
$
INCOME
+
$
Total amount of all contributions (prom line 1A in Schedule 1)
+ $
5,329.39
Refund of nomination filing fee
+ $
Sign deposit refund
...........
+ $
Revenue from fund- raising events not deemed a contribution (prom Part III of
+
Schedule 2)
+
$
Interest earned by campaign bank account
+ $
$
Other (provide full details)
........ ............
..... .................
$
1.
+ $
--
- - -- - - -- - - -- - -- ....._ ........
2.
+ $
$
--
3.
+ $
Total Campaign Income (Do not include loan)
= $
5,329.39 C1
EXPENSES (Note: include the value of contributions of goods and services)
+
$ - - -- - --
Expenses subject to spending limit
+
$
Nomination filing fee
+ $
200.00
Inventory from previous campaign used in this campaign (list details in Table 5
+
$
of Schedule 1)
+
$
Advertising
+-
1,40147
Brochures /flyers
+
$ 0.00 C3
Signs (including sign deposit)
+ $
3,724.98
Meetings hosted
+
Office expenses incurred until voting day
+
Phone and /or Internet expenses incurred until voting day
+ $
Salaries, benefits, honoraria, professional fees incurred until voting day
+ $
Bank charges incurred until voting day
+ $
2.94
Interest charged on loan until voting day
+ $
Other (provide full details)
1. -- -
+ $
—.... ........ ........ ._..__..— ..........
2.
+ $
_..w ...... ....... -- -_ ............. .... ..._. ............... _
3.
+
. -.. - --
$
__ -- - ..............
Total Expenses subject to spending limit
=
_..m._�
$ 5,329.39 C2
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 partylappreciation notices
+
$
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 to recount
+
..... .................
$
Expenses related to controverted election
+
$
Expenses related to compliance audit
+
$
Expenses related to candidate's disability (provide full detains)
1. - - - --
+
_.....__ ... - -- -
_ .............. ..- ............._
2. - -- -
+
$ - - -- - --
......... ......... -
3.
+
$
Other (provide full details)
1. _, -- - - - - - --
+
$
2.
+
$
3.
+
Total Expenses not subject to spending limit
=
$ 0.00 C3
Total Campaign Expenses (C2 + C3)
= $ 5,329.39 C4
9503x' (2013111) Page 2 of 8
B ox D: dalculation qfSurphumorDwfkdt
Excess oV)mf income over expenses (Income — Total Expenses)
(C1—C4) + $ 0.00 D1
Eligible deficit carried forward by the candidate from the last election — $ O.00 D2
Total (D1—Q2) = $ 8.00
Uf there ino surplus, deduct any refund of candidate's ur
spouse's contributions tm the campaign — $ 8.00
Surplus (or deficit) for the campaign � � 0.00 D3
|f line D3 shows a surplus, the amount must be paid |n trust, a1 the time the financial statements are filed, to the municipal clerk who, was
responsible for the conduct mf the election.
Amount ofs
paid to municipal clerk in the municipality of
9503P (2013/11) Page 3 of 8
Schedule I - Contributions
Part| — Summmerycf Cqnhibuduma
Contribution from candidate (include the value of inventory listed in Table 5) + 377939
Contribution from spouse + 0.00
Total 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
includecortribuitions from candidate mspouse). + 0.00
Total value of contributions exceeding $1, 00 per contributor (from line I8;list
details inTables 1 —4)
m
Include ticket revenue, contributions in money, goods and services where
the total contribution from e contributor exceeds $1U0 (do not include
contributions from candidate orspoupe). + � 220000
Less: Contributions returned mr payable to the contributor — $ 65O.OA
Contributions paid ur payable to the clerk, including contributions from
anonymous sources exceeding $1O O'o0
Total Amount of Contributions (Record in Box C) � 53Z939 1A
Part O— List of Contributions from Each Single Contributor Totalling more than $10V
Table 1: Monetary contributions from individuals other than candidate nrspouse
Name
Full Address
Amount $
Duane R. Milot
181 University Avenue, Suite 2200, Toronto, ON M5H 3M7
500.00
Morrison Reist
279 Queen Street Sout, Kitchener, ON N2G I W4
400.00
Ian Smith
3128 Governor's Road, Lynden, ON LOR ITO
250.00
El Additional information is listed on separate supplementary attachment Total
1,150.00
9503P (2013111) Page 4 of 8
Table 2: Monetary contributions from corporations wnunions
Name (Legal and Carrying on
Full Address
President or
Authorized
Amount $
Business As)
Business Manager
Representative
RabideaU Debt Law
50 1 -305 King Street W.
Geoff Rabideau
Geoff Rabideau
750M
Professional Corporation
Kitchener, ON N2G 1139
Steven Lubczuk Law
531 Forst Hill Drive
Steven Lubczuk
Steven Lubczuk
300.00
Professional Corporation
Kitchener, ON N2M 5N5
Additional information is listed
on separate supplementary attachment
Total
1,050,00
Table 3: Contributions in goods mr services from individuals other than candidate orspouse
(Note: must also be recorded as e penses In Box C)
Name Full Address Description, of Goods Value $
or Services I
[] Additional, information io listed on separate supplementary attachment Total 1 0{X)
9503P (2013/11) Page 5 of 8
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 $
l
(Legal and Carrying on Business Manager Representative Goods or Services
Business As) I —
❑ Additional information is listed on separate supplementary attachment
Total Part 11 Contributions (Add Totals from Tables 1-4) (Record in Part I - Summary)
Part III - 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)
Total 1 0.00
$ 220,0.001 B,
Description
Date Acquired
(yyyy/mm/dd)
Supplier
Current Market
Value $
Quantity
....... ........ .
Total Value $
. ...... ........
......
---
. . ....
. ......
. .. . ........
. . .........
[] Additional information is listed on separate supplementary attachment
Total � 0.00
9503P (2013111) Page 6 of 8
Schedule 2 — Fundraising Events and Activities
Fundralsing Event/Activity
Complete a separate schedule for each event or activity held
❑ Additional schedule(s) attached
Description of fundraising event/activity
Date of event/activity (yyyylmm /dd)
Part I — Ticket Revenue
Admission charge (per person)
(If there are a range of ticket prices, attach complete breakdown of all ticket
sales) + $
Number of tickets sold X
Total Ticket Revenue (2A x 2B) (include in Schedule 1)
Part II — Other revenue deemed a contribution
(provide details (e.g, revenue from goods sold in excess of fair market value))
_ 2A
2B
= e
1.
+
$
2.
+
$
3.
+
$
4.
+
$
5.
+
$
Total Part II 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))
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)
= P
19
= e
9503P (2013/11) Page 7 of 8
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
Municipality Date (yyyytmmldd)
Contact Information
Name Licence Number
Last Name First Name
Address
Suite /Unit No. Street No. Street Name
City/Town 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
❑ 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.
9503P (2013111) Page 8 of 8