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Candidate - Form 4
Municipal Elections Act, /0Q0(Section 88.26)
Instructions
All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses must complete Boxes C, D,
Schedule and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in excess of $10,000 must also
attach enAuditor'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 ofthe election.
vvvY mm oo vYYv mw oo
For the campaign period from (day candidate filed nomination) | | | | to | | |
F,-/] Initial filing reflecting finances VoDecember 31 (or 45days after voting day inaby-elecdon)
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 ballot
Last Name or Single Name Given Name(s)
Tremble Laurie
Office for which the candidate sought election Ward name or no. (if any)
Truste Waterloo Region District School Board Kitchener
Municipality
Kitchener
SpnndingLhnh-Genera| SpendingLimk-PartieoondOtharExpmaaionoo[Appmciahon
$ 104'86420 |$ 1046042
Fl I did not accept any contributions or incur any expenses. (Complete Boxes A and B only)
Box B: Declaration
|. Laurie Tremble
statements and attac,4ed supporting schedules are true and correct.
.declare that to the best ofmyknowledge and belief that these financial
2018/11/24
Date (yyyy/mm/dd)
Date Filed (yyyy/mm/dd) Time Filed Initial ufCandidate orAgonk(if0edinperson) Signature ufClerk urDesignate
//^'V Aw, ���- ~
Ranjeni Reddy, a Commissioner, etc.,
Province of Ontario, for the
Corporation of the City of Kitchener,
Expires August 27, 2021
9503P (2018/04) 0 Queen's Printer for Ontario, 2018 Disponible en franpis Page 1 of 8
Box C: Statement of Campaign Income and Expenses
LOAN
Name ofbank orrecognized lending institution
Amount borrowed
�
INCOME
Total amount ofall contributions (from line 1AinSchedule 1)
Revenue from items $25orless
Sign deposit refund
Revenue from fundraising events not deemed acontribution (from Part III of
Schedule 2)
Interest earned bycampaign bank account
Other (provide full details)
'
_
3.
4.
5.
Total Campaign Income (Do not include loan)
+ $ 4500.00
+�
+
+
�
�
+�
= $ 4,500.00 c1
EXPENSES (Nmo:include the value ofcontributions ofgoods and services)
Expenses subject to general spending limit
Inventory from previous campaign used inthis campaign (list details in Table 4cf
$
Schedule 1)
+
Advertising
+
83.84
Brochures/flyers
+ $
243514
Signs (including sign deposit)
+ $
432 .75
Meetings hosted
+ $
Office expenses incurred until voting day
+ $
5.53
Phone arid/or intemetexpenses incurred until voting day
+ *
Ga|aheo, beneMto, honoraria, professional fees incurred until voting day
+ $
Bank charges incurred until voting day
+ $
10.65
Interest charged onloan until voting day
+ $
Other (provide full details)
1. website
+ $
52&89
2. website
+$
75.30
3.website images
+ $
3.89
4. distribution oTdoor hangers
+$
480.25
5.
+$
Total Expenses subject Uogeneral spending limit
= $
4056,44 C2
EXPENSES
Expenses subject to spending limit for parties and other expressions of appreciation
1. gift cardsfQvolunteers and thank you cards+ $ 381.24
_ _
— -
_ $
5. +$
Total Expenses subject tospending limit for parties and other expressions
of appreciation = $ 381.24 C3
9503P (2018/04) Page 2 of 8
Expenses not subject to spending limits
Accounting and audit
+ $
Cost of fundraising events/activities (list details in Part |V of Schedule 2)
+ $
Office expenses incurred after voting day
+ $
Phone and/or intomoiexpenses incurred after voting day
+ $
Sa|ariaa, bonnfito, hnnorarim, professional fees incurred after voting day
+ $
Bank charges incurred after voting day
+ $ 3.95
Interest charged onloan after voting day
+ $
Expenses related torecount
+ $
Expenses related tocontroverted election
+ $
Expenses related tocompliance audit
+ $
Expenses related tncandidate's disability (provide full details)
1.
+ $
2.
+ $
3.
+$
4.
+$
b.
+$
Other (provide full details)
1. + $
2. +$
1 +$
4. +$
5 +$
Total Expenses not subject oospending limits = $ 3.96C4
Total Campaign Expenses (C2 + C3 + C4)
Box D: Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income minus Total Expenses)
(C1—05) + $ 50.37 D1
Eligible deficit carried forward bythe candidate from the last election
(applies 1o2O18regular election only) — $ D2
Total (D1—D2) = $ 68.37
|fthere iaaSurplus, deduct any refund ufcandidate's or
spouse's contributions Nthe campaign — $ 58.37
Surplus (or deficit) for the campaign = $ DJ
= 14,441.63 C,5
|fline D3shows usurplus, the amount must bepaid intrust, at the time the financial statements are filed, Vothe municipal clerk who is
9503P (2018/04) Page 3 of 8
Schedule I - Contributions
Part|—SummoryofCunthbudona
Contributions inmoney from candidate and spouse
Contributions ingoods and services from candidate and spouse
(include value listed inTable 3and Table 4)
Total value ofcontributions not exceeding $1OOper contributor
`
Include ticket revenue, contributions inmoney, goods and services
where the total contribution from mcontributor ia$1OUorless (do not
include contributions from candidate nropouno).
Total value of contributions exceeding $100 per contributor (from line 1 B on page 5;
list details inTable 1and Table 2)
^
Include ticket revenue, contributions inmoney, goods and services where
the total contribution from acontributor exceeds $1OO(do not include
contributions from candidate orupouua).
Less: Contributions returned orpayable 0othe contributor
Contributions paid mpayable iothe derk, including contributions from
anonymous sources exceeding $25
Total Amount ofContributions <mourd under Income in Box C>
Part 11 —Contributions exceeding $100 per contributor— individuals other than candidate or spouse
Table 1: Monetary contributions from individuals other than candidate or spouse
AmounL$
Name Full Address |Date Received|Amount Received $�or
[�m��C���r
| | | Paid!oCle,k
[:] Additional information is listed on separate supplementary attachment Total
9503P (2018/04) Page 4 of 8
Table 2: 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 Date Received Value $
or Services (yyyy/mm/dd)
F�Additional information iolisted onseparate oupp|emen1aryattachment Total |
Total for Part U'Contributions exceeding $10Oper contributor
(Add totals from Table I and Table 2 and record the total in Part I - Summary of Contributions) 1B
PartU|—contributions from candidate orspouse
Table 3: Contributions in goods or services
Description of Goods or Services Date Received Value $
[:] Additional information iulisted onseparate oupplemantaryattachment Total |
9503P (2018/04) Page 5 of 8
Table 4: Inventory of campaign goods and materials from previous municipal campaign used in this campaign
(Note: value must be recorded as a contribution from the candidate and as an expense)
Description Date Acquired Supplier Quantity Current Market
[—] Additional information islisted onseparate supplementary attachment
Total
9503P (2018/04) Page 6 of 8
Schedule 3—Fundraising Events and Activities
I'undmisingEvent/AcUvhy
Complete a separate schedule for each event or activity held
[:] Additional acheule(s)attached
Description n[fundraising event/activity
Date ofevent/activity (yyyy/mm/dd)
Part |— Ticket revenue
Admission charge (per person)
(If there are arange ofticket prices, attach complete breakdown ofall ticket
ua|em)
$ 3A
Number oftickets sold
x
2B
Total Part |(2AX2B) (include inPart 1ofSchedule 1)
PartU—OxhormvenuedeemeduoonuibuUon
(e.g.revenue from goods sold inexcess o/fair market value)
Provide details
1.
+
$
2.
+
$
8.
+
$
4.
+
$
5.
+
$
Total Part U(include inPart 1 ofSchedule 1)
PartU|—Othormvenuonotdo*medocunthbudoo
(e.g.contribution o/$25orless; goods urservices sold for $25orless)
Provide details
1.
+
$
2.
+
$
8.
+
$
4.
+
$
5.
+
$
Total Part III (include under Income inBox C>
PanK/—Expaneesrmhatedtofundmisingaventoraobvity
Provide details
1.
+
$
2.
+
$
3.
+
$
4.
+
$
5.
+
$
O.
+
$
7.
+
$
8.
+
$
Total Part IV Expenses (include under Expenses in Box C)
9503P (2018/04) Page 7 of 8
Auditor's Report
Municipal Elections Act, Y0Q0(Section 88.25)
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 ate (yyyy/mm/dd)
Contact Information
Last Name or Single Name Given Name(s) Licence Number
Address
Suite/Unit No. Street No. Street Name
Municipality Province Postal Code
Telephone No. (including area code) Email Address
The report must be done in accordance with generally accepted auditing standards and Must:
`
set out the scope ofthe 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 88.25 and 95 of the Municipal Elections
Act, 1996.Under section O8ofthe Municipal Elections Act, 1090(and despite anything inthe Municipal Freedom ofInformation 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 (2018/04) Page 8 of 8