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Home My WebLink AboutDupuis, Kevin:> Ontario Ministry of Municipal Affairs Financial Statement - Auditor's Report Candidate - Form 4 Municipal Elections Act, 1996 (Section 88.25) Instructions All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses 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 their spouse) shall be paid immediately over to the clerk who is responsible for the conduct of the election. YYYY MM DD YYYY MM DD For the campaign period from (day candidate filed nomination) 2 0 1N. 0 7_[ 1 t® 1 2 0 1 8 1 1 11 0 Initial filing reflecting finances to December 31 (or 45 days after voting day in a by-election) Supplementary filing including finances after December 31 (or 45 days after voting day in a by-election) Box A: Name of Candidate and Office Candidate's name as shown on the Io t Last Name or Single Name Given Name(s) Dupuis Kevin on I Ward name or no. (if a - Municipality City of Kitchener Spending Limit - General Spending Limit - $ 1 $ [:] I did not accept any contributions or incur any expenses. (Complete Boxes A and B only) Box B: Declaration I, Kevin Dupuis declare that to the best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. ao) 2—o Y� q I � 2018/12/17 Date (yyyy/mm/dd) mmsmsm= 0 &503P (2018/04) 0 Queen's Printer for Ontario, 2018 Disponible en frangais Page 1 of 8 Box C: Statement of Campaign Income and Expenses Name nfbank orrecognized lending institution Amount borrowed � Urq*-T,Tll-� Total amount ufall contributions (from line 1AinSchedule i) + $ 1.24 Revenue from items $25orless + Sign deposit refund + Revenue from fundraising events not deemed acontribution (from Part III uf $ Schedule 2) + Interest earned bycampaign bank account + $ Other (provide full details) i.+ $ Z +$ � +� 4k +$ 5. +$ Total Campaign Income (Do not include loan) $ l 241c1 EXPENSES (Nota:include the value ufcontributions nfgoods and services) Expenses subject 6mgeneral spending limit Inventory from previous campaign used in this campaign (list details in Table 4 of $ Schedule 1) + Advertising + Brochures/flyers + $ Signs (including sign deposit) + $ Meetings hosted + $ Office expenses incurred until voting day + $ Phone and/or intnmetexpenses incurred until voting day + � 1.24 8a|ahea, benefito, hnnnnaho, professional fees incurred until voting day + $ Bank charges incurred until voting day + $ Interest charged onloan until voting day + � Other (provide full details) z +$ 2. + $ 3, + $ wL 5� |oum� ��n�aoub j ectougenera|spending limit = $ 1.24 C2 EXPENSES Expenses subject tospending limit for parties and other expressions ofappreciation 1. + $ 2' + $ �. + $ 4.r $ 5.+ $ Tmt|��A�nm��mt��ot0map�nd|n�Um|%�wrparties and other expressions of appreciation = C3 9503P (2018/04) Page 2 of 8 Expenses not subject to spending limits Accounting and audit Cost of fundraising events/activities (fist details in Part IV of Schedule 2) 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) I, 2. 3. 4. 8. Other (provide full details) Ii,, $ 2. +$ 3 4. $ 5. + $ Total Expenses not subject to spending limits C4 Total Campaign Expenses (C2 + C3 + C) Excess (deficiency) of income over expenses (Income minus Total Expenses) (Cl - C5) + $ 0.00 DI Eligible deficit carried forward by the candidate from the last election (applies to 2018 regular election only) mm D2 Total (D1 - 132) - If there is a surplus, deduct any refund of candidate's or spouse's contributions to the campaign Surplus (or deficit) for the campaign w D13, $ 1.24 C 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 is responsible for the conduct of the election. 9503P (2018/04) Page 3 of 8 Part I — Summary of Contributions Contributions in money from candidate and spouse ° $ 1.24 Contributions in goods and services from candidate and spouse (include value listed in Table 3 and Table 4) $ Total value of contributions not exceeding $100 per contributor w 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 1 B on page 5; list details in Table 1 and Table 2) 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 _ __ .......m� anonymous sources exceeding $25 — Total Amount of Contributions (record under Income in Box C)�2 4 q exceedingPart 11 — Contributions candidate.. :. Table 1: -Monetary -contributions from individuals other than candidate or spouse Full M Address. Wz. M 7ount $ turned to Contributor Paid to Clerk 9503P (2018/04) Page 4 of 8 (Note: must also be recorded as Expenses in Box C) Name�' Full Address j Description of Goods Date Received Value $ or Services I (yyyy/mm/dd} Additional information is listed on separate supplementary attachment Total Total for Part II - Contributions exceeding $100 per contributor (Add totals from Table 1 and Table 2 and record the total in Part 1 - Summary of Contributions) $ 1D Table 3: Contributions In goods or services 9503P (2018/04) Page 5 of 8 0 Additional information is listed on separate supplementary attachment a• ,TEA= it ROOMIER= Ilk: L0114wr III 1�31 a ISFIS -1�2 i4n.] lip Lq- IF FF KwM il GMIM-1 i a i gol i j 14 Mayr -I iteltor-MIRI 1 9 j i E, ^ i 0 1 0 EjwF 1:1 Additional information is listed on separate supplementary attachment HM kVIF1 [FFIF 9503P (2018/04) Page 6 of 8 Schedule 2 — Fundraising Events and Activities Fundraising EventlActivity Complete a separate schedule for each event or activity held Description of fundraising event/activity Date of event/activity (yyyy/mm/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 Total Part I (2A X 2B) (include in Part I of Schedule 1) Part 11 - Other revenue deemed a contribution (e.g. revenue from goods sold in excess of fair market value) Provide details I" 2. 3 . .. .,N ............. . . . ............................. — - - —...m............, ......................... 4, 5, . . . .................... . ............ Total Part 11 (Include In Part I of Schedule 1) Part III - Other revenue not deemed a contribution (e.g. contribution of $25 or less; goods or services sold for $25 or less) Provide details 2. 4, 5, ......... . . . . . ........ -- . ....... ................................................. . . ................ ....................... .................... ............ . .. Total Part III (include under Income In Box C) Part IV - Expenses related to fundralsing event or activity Provide details 1. 3. .,mm, ................. . 4, ....................................... 5, . . .......... . 6" 7, Total Part IV Expenses (include under Expenses in Box C) M 9 R 7.: $ =1 M 9503P (2018/04) Page 7 of 8 Auditor's Report �uMunicipal Elections Act, 1996 (Section 88.25) Aoandidate who has received contdbutions or incurred expenses in excess of $10,000 must attach an auditor's report. Professional Designation of Auditor Dat*(yyyyhnm/dd) Contact Information Last Name or Sinale I Address Suite/Unit No. Street No. Street Name : MOMMIN ngarea cuoe |tnem*oon*ao 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 itiafree ofmaterial misstatement Personal information, ifany, collected onthis form isobtained under the authority ofsections 88.25and 85ofthe Municipal Elections Act, YQQ6.Under section 88ofthe Municipal Elections Act, YQQO(and despite anything inthe Municipal Freedom ofInformation and Protection of Privacy Aco 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 (2018/04) Page 8 of 8 ' Bill, To: Kevin Dupuis +1.5196690480 .COM Domain Registration Item Number: 101 Quantity: 1 Term: 1 Payment lnfwmcMo Kevin Du pui MATIMMK3 1=1 Fees: C$0.25 Taxes: C$0.00