HomeMy WebLinkAboutStrohack, SteveMinistry of Municipal Affairs Financial Statement — Auditor's Report
and Housing
Ontario 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 $110,000 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 DID YYYY mm DID
For the campaign period from (day candidate filed nomination) i jo A to
0 Primary filing reflecting finances to December 31 (or 45th day after voting day in a by-election)
E] Supplementary filing including finances after December 31 (or 4511' 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)
sirollack Steve
Name of office for which the candidate sought election Ward name or no. (if any)
Comic illor � 9
jName of Municipaiiiy_
Kitchener
Spending limit issued by clerk
�S14 , C) ,,
❑ I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and B only)
Box B: Declaration
1, Stcvc Sirohack
, a candidate in the municipality of
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
on (yyyylTrn/dd)
I _It.. c.
Signature of Clerk or Commissioner
Date Filed in the Clerk's Office (yyyy/mm/dd)
Patricia Mario Harris, a Commissioner, etc.,
Regional Municipality of Waterloo,
for the Corporation of the City of Kitchener`.
Expires June 30, 2016,
Sighature of Candidate
9503P (2013111) 0 Queen's Printer for Ontario, 2013 DisponNe en franpis Page 1 of 8
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)
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.
+ $
+ $
+ $
1.1-17.06
TOO)
OO)
Total Campaign Income (Do not include loan)
_ $
4,347.26 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)
+ $.
Advertising
+ $
23,29
Brochures /flyers
+ $
1,453.91
Signs (including sign deposit)
+ $
1.288.20
Meetings hosted
+ $
Office expenses incurred until voting day
+ $
1 M52.57
Phone and/or Internet expenses incurred until voting day
+ $
143.77
Salaries, benefits, honoraria, professional fees incurred until voting day
+ $
251.00
Bank charges incurred until voting day
+
Interest charged on loan until voting day
+ $
Other (provide full details)
1.
+ $
2.
$
-
+ $
Total Expenses subject to spending limit = $ 4,339.26 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
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
E=xpenses 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
Total Campaign Expenses (C2 + C3)
+ S
--
+ $.. 8.00
+ $
+ $
+ $
= $
8,00 C3
$ 4,3347.20 C4
9503P (2013111) Page 2 of 8
Box D. Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income — Total Expenses)
(Cl — C4) + $ 0. {)0 131
Eligible deficit carried forward by the candidate from the last election — $ _ 0,00 D2
Total (131 — 132) W $ 0,M)
If there is a surplus, deduct any refund of candidate's or
spouse's contributions to the campaign — $ 0.00
Surplus (or deficit) for the campaign — $ 0.01) 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 8
Schedule 1 - Contributions
Part I — Summary of Contributions
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 in money, goods and services
where the total contribution from a contributor is $100 or less (do not
include contributions from candidate or spouse). + $ _
Total value of contributions exceeding $100 per contributor (from line 16; 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). + $ ..
Less: Contributions returned or payable to the contributor - $_
Contributions paid or payable to the clerk, including contributions from
anonymous sources exceeding $10 -
Total Amount of Contributions (Record in Box C) _ $
;806.'6
340.00
10 1.00
4,247,20 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 $
(Wol'f S( c11-16 192 Kent A% e. K itchencr Ontario ',2G 3R-1 `;x101,00
Additional information is listed on separate supplementary attachment
Total
9503P (2013/11) Page 4 of 8
Table'2: Monetary contributions from corporations or unions
Name (Legal and Carrying on Full Address President or Authorized Amount $
Business As) Business Manager Representative
j 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
r
Additional information is listed on separate supplementary attachment
Total
9503P (2013111) Page 5 of 8
T k! e• r in n„nrla nr anrvicPm from cnrnnr;h inns or anions (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 $
L. 1 Additional information is listed on separate supplementary attachment Total
Total Part II Contributions (Add Totals from Tables 1-4) (Record in Part I — Summary) 113
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 Supplier Current Market Quantity Total Value $
(yyyylmmldd) I Value $
Additional information is listed on separate supplementary attachment
Total
9503P (2013/11) Page 6 of 8
Q,k- .d. 7 _ CIFHAY ;i -n r--f. 4 A,fh,ifinc
Fundraising 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 (yyyy /mm /dd)
Local ImNe : A Fundrasier to support tile callipait n to elect Steve Strollack
20 1=4 110 91i 15
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)
1 0.00 2A
,34 2B
$ 340.01.1
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)
= C
�.
9503P (2013111) Page 7 of 8
Auditor's Report
Municipal Elections Act, 9996 (Section 78)
A candidate who has received contributions or incurred expenses in excess of $1o,000 must attach an auditor's report.
Professional Designation of Auditor
Municipality
Contact Information
Name
Last Name
Address
Suite /Unit No. I Street No. Street Name
City/Town
Telephone No. (including area code) I Fax No.
ext. jk
First Name
Province
Email Address
udtC IYYYYI111111,uU!
Licence ivurnoei
Fostal L;ooe
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
i 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