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Ministry of Municipal Affairs Financial Statement - Auditor's Re ort
i✓r Ontario and Housing Form 4 p
Municipal Elections Act 9996 (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 X 2 9 1 to 0 1 4 1 1 2 3 1
❑J Primary filing reflecting finances to December 31 (or 45th day after voting day in a by- election)
❑ Supplementary filing including finances after December 31 (or 45'h 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)
Martin Ted
Name of office for which the candidate sought election Ward name or no. (if any)
Trustee - Waterloo Region District School Board
Name of Municipality
City of Kitchener
Spending limit issued by clerk
$ 103,605.95
❑ 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. Ted Martin a candidate in the municipality of
City of Kitchener hereby declare that to the best of my knowledge and belief that these
financial statements and attached supporting schedules are true and correct.
Declared be,f (clerk or co misssiioon Tc 0
in the C_t�4 3 . t r
on (yyyylmmldd)
O
Signature of or Commissioner
Date Filed in the Clerk's Office (yyyylmmldd)
Colin Matthew Coodeve
Deputy City Clerk
�� -1
Signature of Candidate
9503P (2013111) ® Queen's Printer for Ontario, 2013 DisponNe an frangais Page 1 of 10
Box C: Statement of Campaign Income and Expenses
LOAN
Name of bank or recognized lending institution
Amount borrowed $
INCOME
Total amount of all contributions (From line 1A in Schedule 1)
+
$ 2,823.94
Refund of nomination filing fee
+
$ 100.00
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)
_
$ 2,923.94 c1
EXPENSES (Note: include the value of contributions of goods and services)
Expenses subject to spending limit
Nomination filing fee
+
$ 100.00
Inventory from previous campaign used in this campaign (list details in Table 5
of Schedule 1)
+
$ 108.00
Advertising
+
$ 1,122.81
Brochureslflyers
+
$ 868,97
Signs (including sign deposit)
+
$ 576.30
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
=
$ 2,776.08 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 party /appreciation notices
+
$ 147.86
Office expenses incurred after voting day
+
$
Phone and/or Internet expenses incurred after voting day
+
$
Salaries, benefits, honoraria, professional fees incurred after voting day
+
$
Sank 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.
+
$
2.
+
$
3.
+
$
Other (provide full details)
1.
+
$
2.
+
$
3.
+
$
Total Expenses not subject to spending limit
$ 147.86 C3
Total Campaign Expenses (C2 + C3)
_ $ 2,923.94 C4
9503P (2013111)
Page 2 of 10
Box D; Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income — Total Expenses)
(Cl — 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
9503P (2013151) Page 3 of 10
Name (Legal and Carrying on
Business As)
Full Address
President or
Business Manager
Authorized
Representative
Amount $
650.00
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 Descriptlon of Goods Value $
or Services
Craig Miller Boeli ner St Kitchener ON N2H website design
200.00
t70 3
200.00
❑ Additional information is listed on separate supplementary attachment Total
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 C)
Name of Corporation Full Address President or Authorized Description of Value $
(Legal and Carrying on Business Manager Representative Goods or Services
Business As)
F1 Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part I — Summary) 1B
Part III — Inventory
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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
(yyyylmmldd)
Supplier
Current Market
Value $
Quantity
Total Value $
signs & stakes
various suppliers
in 1997, 2000 and
2006
4.5024
108.00
108.00
❑ Additional information is listed on separate supplementary attachment
Total
9503P (2013111) Page 8 of 10
Schedule 2 - Fundraising Events and Activities
Fundraising Event/Activity
Complete a separate schedule for each event or activity held
D Additional schedule(s) attached
Description of fundraising event/activity
Date 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 1V Expenses (include in Box C)
9503P (2013111) Page 9 of 10
Auditor's Report
Municipal Electrons 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
Contact Information
Date (yyyy /mmldd)
Last Name First Name Licence Number
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 Froodom 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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