HomeMy WebLinkAboutKhan, Rehman-UllahMario 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 Auditors 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,.
"YYMM DD YYYY MM DD
For the campaign period from (day candidate filed nomination 2 — 1 to 2- i
Ini iiial 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 ballot
Last Name or Single Name Given Name(s) i
Office for which the candidate sought election Ward name or no.' (if'a'ny)�
Municipality
Spending Limit - Genera
Spending Limit - Parties and Uther Expressions of Appreciation
I did not accept any contributions or incur any expenses. (Complete Boxes A and B only)
Box B: Declaration
i„j ,_clare that to the best of my knowledge and belief that these financial
statements and attached supporting schedules are true and correct,
re
ll03-2-1_ .........................
Date (yyyy/mm/dd)
Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (if filed in person) Signature of Clerk or Designate
aol9 /031 a-? a ,- 0 Pr^ d & . ee��.
9503P (2018/04) 0 Queen's Printer for Ontario, 2018 Disponible en franpais Page 1 of 8
........... .............. ..
Box C: Statement of Campaign Income and Expenses
..__. ......... . m... ........................... _
LOAN
Name of bank or recognized lending institution
Amount borrowed
EXPENSES (Note: include the value of contributions of goods and services)
Expenses subject to general 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)
+
w
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
+i
Bank charges incurred until voting day
+
Interest charged on loan until voting day
+
Other (provide full details)
�
EXPENSES
Expenses subject to spending limit for parties and other expressions of appreciation
�)/
9503P (2Q18104) Page 2 of 8
Expenses not subject to spending limits
Accounting and audit + $
................
Cost of fundraising events/activities (list details in Part IV of Schedule 2) + $
.,.........
Office expenses incurred after voting day + $
Phone and/or internet expenses incurred after voting day ,f, $
Salaries, benefits, honoraria, professional fees incurred after voting day $
Bank charges incurred after voting day + $�w
Interest charged on loan after voting day + '$
Expenses related to recount + $
Expenses related to controverted election + $
Other (provide full details)
Total Campaign Expenses (C2 + C3 + C4)
Box D: Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses (Income minus Total Expenses)
(Cl — C5)
Eligible deficit carried forward by the candidate from the last election
(applies to 2018 regular election only)
Total (01 — 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
.r D1
$ D2
Lim
$ C5
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
Schedule 1 -Contributions
_. ........... ........................... ......... ......__ ...................
Part I — Summary of Contributions
Contributions in money from candidate and spouse $
........................................................................
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
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).
......... ............................................. m.
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
anonymous sources exceeding $25
Total Amount of Contributions (record under Income in Box C) 1A
Part II — Contributions exceeding $100 per contributor— individuals other than candidate or spouse
Table 1: Monetary contributions from individuals other than candidate or spouse
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 GoodsJReceived Value $
�(Yyyylmmi
or Services
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) 1B
Part III — Contributions from candidate or spouse
Table 3: Contributions in goods or services
9503P (2018/04) N 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)
9503P (2018/04) Page 6 of 8
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 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)
2A
Number of tickets sold X 2B
Total Part I (2A X 2B) (include in Part 1 of Schedule 1)
Part IV — Expenses related to fundraising event or activity
Provide details
r
9503P (2018104) Page 7 of 8
. ........ .. ww,w. ........
Auditor's Report
Municipal Elections Act, 1996 (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
nicipa
Contact Information
Name or Single Name
Address
Suite/Unit No. I Street No_ Street Name
Mun
Telephone No, (including area
The report must be done in accordance with generally accepted auditing standards and must:
Date (yyyy/mm/dd)
nce
Postal Code
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 88.25 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 (2018/04) Page 8 of 8