HomeMy WebLinkAboutFernandes, YvonneOntario minis" of Municipal Affairs Financial Statement - Auditor's Report
and Housing Form 4
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 $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) 1 2 0 1 4 1 0 2 1 2 0] to 2 0 1 4 1 1 2 13 tj
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: Name of Candidate and Office
Candidate's name as shown on the ballot
Last Name Given Name(s)
FERNANDES YVONNE
Name of office for which the candidate sought election Ward name or no. (if any)
COUNCILLOR 4
Name of Municipality
KITCHENER
Spending limit issued by clerk
16,974.80,
1 did not accept any contributions or incur any expenses other than the nomination fee, (Complete Box A and B only)
Box B: Declaration
i, YVONNE FERNANDES a candidate in the municipality of
KITCHENER, ONTARIO 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 1,j -I, � J� k,/6,
on (yyyylmm/dd)
Signature ,qf,0brk or Commissioner
A) ; A-
Date Filed in the Clerk's Office (yyyy/mm/dd)
COUR MattheW CoWeVe
Deputy City Clerk
KI-q "s
Signature of Candidate
J
9503P (2013/11) & Queen's Printer for Ontario, 2013 Disponible an frangais Page 1 of 10
Box C: Statement of Campaign Income and Expenses
LOAN
Name of bank or recognized lending institution'FI) CANADA TRUST
Amount borrowed $
INCOME
Total amount of all contributions (From line 1A in Schedule 1)
Refund of nomination filing fee
Sign deposit refund
Revenue from fund-raising events not deemed a contribution (From 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)
EXPENSES (Note: include the value of contributions of goods and services)
Expenses subject to spending limit
Nomination filing fee
Inventory from previous campaign used in this campaign (list details in 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
Salaries, benefits, honoraria, professional fees incurred until voting, day
Bank charges incurred until voting day
Interest charged on loan until voting day
Other (provide full details)
1.
2.
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 party/appreciation 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 details)
1,
Total Expenses not subject to spending limit
Total Campaign Expenses (C2 + C3)
9503P (2013111)
+ $ 4,270.05
+ $ 100.00
4,370.05 cil
+ $ 100,00
* $
72T50
* $,
* $
690.70
1,52168
+ $
810,71
+ $
162.22
+ $
14.81
+ $
1' 45.97
$
42174.59 C2
+ $
17151
172.51 C3
$ 4,347.10 C4
Page 2 of 10
Box D: Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (income — Total Expenses) + $ 22.95 131
(Cl — C4)
Eligible deficit carried forward by the candidate from the last election $ D2
Total (131 — 132) =-$ 22.95
If there is a surplus, deduct any refund of candidate's or $ 22.95
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
9503P (2013/11) Page 3 of 10
Sohedu|wI - Cwmtr|bmtionm
;mrt| — SumnwaryoaContdhuuons
Contribution from candidate (include the value of inventory listed in Table 5)
Contribution from spouse
Total value of contributions not exceeding $100 per contributor
^
Include ticket revenue, contributions |n money, goods and services
where the total contribution from a contributor is $1*0or less (do not
include contributions from candidate oropuueo).
Total value of contributions exceeding $100 per contributor (from line 1B; list details
|m Tables 1-4)
^
Include ticket revenue, contributions in money, goods and services where
the total contribution from ocomtrib,mtor exceeds $10O (do not include
contributions from candidate ormpoume).
Less: Contributions returned or payable t* the contributor
Contributions paid ur payable &o the clerk, including contributions from
anonymous sources exceeding *10
Total Amount of Contributions (Record in Box C)
*$
*v
+$ l
= � 4,270.05 1A
PartU— 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 $
Mary Ann Vanden Elzen
40 Edgewood Dr Kitchener ON N2M 2A 1
Monika.Rurowski
500 Stauffer RD Kitchener ON
Charles Orniston
508 New Dundee Rd Kitchener ON N2112N7
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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 $
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Total Part 11 Contributions, (Add Totals from Tables 1-4) (Record in Part I - Summary) 1B
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)
Description
Date Acquired
(yyyy1mm/dd)
Supplier
Current Market
Value $
Quantity
Total Value $
Lawti Signs
2010/08/10
TechniBase Inc.
5.82
125
727.50
. .........
95039 (2013111) rays i vi iv
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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
Bate of eventlactivity (yyyylmmldd)
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
2B
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))
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))
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)
_ $
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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
Contact Information
Last Name
Address
Suite /Unit No. Street No. i Street Name
City/Town
Telephone No. (including area code) 1 Fax No. I Email Address
ext.
The report must be done in accordance with generally accepted auditing standards and must:
Date (yyyylmmldd)
nce
• 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.
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