HomeMy WebLinkAboutMalik, LalaMinistry of Municipal Affairs Financial Statement - Auditor's Report
Ontari o 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) Lao I t/ 0 0 1. . L),� to LAN _L/ A1.0
—1
F1 Primary filing reflecting finances to December 31 (or 45wh day after voting day in a by-election)
D 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 as shown on the ballot
Last Name
me
candidate sought election
Name of Municipality
V1 , /C A e, J) o r
Spending ._
S I �?
by clerk
5--5-
Given Name
Ward name or no. (if any)
{r✓04,i�J S-
E] I did not accept any contributions or incur any expenses other than the nomination fee, (Complete Box A and B only)
Box 8: Doclaration
. 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)
ti
in the
on (yyyy/mrn/dd)
. ...... - - -- - ------------- - 1.
_ P�p a I u r ";eb' �1,1.r� or Co`mm11 sinner
Date Filed in the Clark's Office (yyyy/mm/dd)
Signature of Candidate
9503P (2013/11) 0 Queen's Printer for Ontario, 2013 Dispon%lo on fran9a;s 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. . .... ...................................... — - - — ------- --
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.
2.
3.
Other (provide full details)
1.
2.
3.
Total Expenses not -subject to spending limit
Total Campaign Expenses (C2 + C3)
9503P (2013111)
+ $
+ $ 11
$ J TO ''0 C1 I
v
+$/00
$
C3 P
C4
Page 2 of 8
+
C2
$
C3 P
C4
Page 2 of 8
Rox D: Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income — Total Expenses)
(Cl — N) + $ 0$ D1
Eligible deficit carried forward by the candidate from the last election D2
XI
Total (DI — 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,
1.
Amount of $ paid to municipal clerk in the municipality of
9503P (2013111) Page 3 of 8
Schedule 1~Contributions
Pad| — Summary nfContributions
Contribution from oum�didato (include the value of inventory listed |nTable 5)
Contribution from spouse
Total value ofrontribmfiono not exceeding $1DQ per contributor
`
Include ticket revenue, contributions im money, goods and services
where the total contribution from a contributor im$1V0mr less (do not
include contributions from candidate ormpouse).
Total value of contributions exceeding $100 per contributor (from line 113; list details
|n 'fables 1-4)
°
Include ticket revenue, contributions |n money, goods and services where
the total contribution from ucooNbuk/r exceeds $1&& (do not include
contributions from candidate orSyoume).
+
+� _q -�- -1 il -
~
�
�+ � '� �� � �
�
m � u/^ ,,3
+� ..
Loss: Contributions returned m payable tu the contributor — $ ~
Contributions paid vrpayable to the clerk, including conhbutioofrom
anonymous sources exceeding *10 — $ �
Totw|Amount of Contributions (Record |vBox C) = $ ^ 1 A
�
PurtU— Liwtuf Contributions from Each Single Contributor Totalling more than $i8O
9503P (2013111) Page 4 of 8
Table 3: Contributions in goods or services from individuals other than candidate or spouse
8503P (2013111) Page 6 of 8
Table 4, Contributions In goods or services from corporations or unions (Note: must also be recorded as expenses in Box C)
Mande of Corporation
(Legal and Carrying on
Business As)
Y)
Full Address
President or
Business Manager
Authorized
Representative
. . .................
Description of
Goods or Services
Value $
. ....... . . .....
. . ...... . .......
......... .
.... . . . ....... . ..... . ..
.... . ................ ..
. ...... ....... . .. .... . .
. .
- - - ------- -
.. . ............... . . . ....
. . .... . .... ..
.
. .. . ............. .
. . . . ......
® 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 6: 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
18
Description
Date Acquired
(yyyy/mm/dd)
Supplier
Current Market
Value $
Quantity
Total Value $
. ....... . . .....
......... .
. . . . . ........... ...
.... . ................ ..
. ... . ..............
. .
- - - ------- -
.. . ............... . . . ....
.
. .. . ............. .
[:] Additional information is listed on separate supplementary attachment
Total
9503P (2013111) Page 6 of 8
i Schedule 2 — Fundraising Events and Activities
Fundraising Event/Activity
Complete a separate schedule for each event or activity held
❑ Additional schedule(s) attached
Description of fundraising eventfactivity YA _ a
Date of eventlactivity (yyyylmmldd) n . C
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
28
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,
+
$
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)
9503P (2013/11) 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 $10,000 must attach an auditor's report,
Professional Designation of Auditor
Municipality Dale (yyyylmmldd)
Contact Information
Last Name I First Name Licence Number
Address
Suite /Unit No. Street No. Street Name
CityfTown
Province
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