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HomeMy WebLinkAboutChapman, Debbiet)�-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. Y"YYY MM DD YYYY MM DD For the campaign period from (day candidate filed nomination) t1 10 5 0 1 to I? 0 1 8 I 1 2 3 1 -. ........ ......... l ............_ L.�, 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 ba : Ilot ......___ ._ Last Name or Single Name Given Name(s) Chapman Debbie candidate soug Municipality Kitchener Spending Limit - Gene F] I did not accept any contributions or incur any expenses. (Complete Boxes A and B only) Box B: Declaration - I, Debbie Chapman declare that to the best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Ze19/(0(/24 I ( . ((0Q.n.. I C. 2019/01/28 Date (yyyy/mm/ddd) person) SigXtrerfClk or Designate 1n� 9503P (2018/04) © Queen's Printer for Ontario, 2018 Disponible en frangais page 1 of 8 mm ,,,,.,m.,.,. ,,,,.,,m Box C: Statement of Campaign Income and Expenses LOAN........., ........ Name of bank or recognized lending institution NA Amount borrowed $ INCOME 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 4 75 Schedule 1) + _ Advertising + $ 2,178.17 Brochures/flyers + $ 2,314.72 Signs (including sign deposit) + $ Meetings hosted + $ Office expenses incurred until voting day + $ 451.92 Phone and/or internet expenses incurred until voting day + $ 134.95 Salaries, benefits, honoraria, professional fees incurred until voting day ,..,. +$ Bank charges incurred until voting day g 9 ......_ + $ ...,,W,w..,,.�w 23.00 Interest charged on loan until voting day + $ Other (provide full details) ____...m... ......... _.... 1. Papal fees + $ 68.40 _ _. _ ..... . _ ........ . _..___.___ '$ 3.+ $ 4. + $ Total Expenses subject to general spending limit $ 7,515.91 C2 9503P (2018104) 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) ...........................................................................................m. + $ Office expenses incurred after voting day +' $ Phone and/or Internet ex enses incurred after voting da p y ...................................................... ...'01. + Salaries, benefits, honoraria, professional fees incurred after voting day + $ Bank charges incurred after voting day + $10-50 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. +$ 4. + $ ................. ........... --- ....__.. .. 5. + '$ Other (provide full details) 1+y ..... ........ __. $ ............ 2.+$ �..,. ........ _..._. ......... . ...........m .......... ._... —... 4t �.... ........ ___„ . _ + $ „m„ 11. ........ . . . Total Expenses not subject to spending limits ...... .... - $ 29.51 C4 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) + $ 122.68 D1 .................®....... Eligible deficit carried forward by the candidate from the last election (applies to 2018 regular election only) 02 Total (01 - D2) - 122.68 If there is a surplus, deduct any refund of candidate's or spouse's contributions to the campaign — $122.68 ...._._ „ Surplus (or deficit) for the campaign $1 D3 - $ 8,872.18 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 ,1.,_ ........ ........ _.. .... __.....____....... _.. ��, �,,,,T,, Part I - Summary of Contributions ............. ....... .... ......... ........ ........ .......... ....................w Contributions in money from candidate and spouse + $ 2,520.00 Contributions in goods and services from candidate and spouse ............ ... .................................... ............................... ................. _....... (include value listed in Table 3 and Table 4) + $ ............................................................ 2,344.75 _. _ _.................... 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). + $ _............................................................................................. . 430.00 ..... - 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 $100 (do not include contributions from candidate or spouse), + '$ 3,400.00 Less: Contributions returned or payable to the contributor - $ 200.00 Contributions paid or payable to the clerk, including contributions from anonymous sources exceeding $25 - $ 200.00 Total Amount of Contributions (record under Income in Box C) $ 8,294.75 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 Amount $ Name Full Address Date Received Amount Received $ Returned to Contributor or Paid to Clerk Glori p. . ......... ........ a Cha man ._....._ ri....... 8 Katherine Cres. Kitchener 2018/08/01 1,050.00 2M 2K1 ................. ...... _ ............................ Jane Harding _ _ _ ....._._ ... ,,,., 12 Michael St, ...... ...................................................... _..�...._ ... _....._.._.._._. Kitchener 2018/08/08 300.00 N2G 1 L8 .. ...... ....... _........ Michael Canivet .._ __ ................ .._......... . 12 Michael St. . ........ Kitchener 2018/10/01 250,00 2G 1 L8 ........ ......_........ Sandy Delamere _.... 577 emmingway N. ...........�.... ...._ ....... ........ ........... __ ........_ ........... Waterloo 2018/08/10 200.00. N2T 14 Dwayne Chapman 1- East Beaver Creek Richmond Hill 2018/08/11 200.06 L4B 1G8 _............ ­. , , ......... ......... Cytlalli Marrato _...... _......... _ ........ .... ........._. 507-438 King S. W, ._._ .... ,.., ,:Toronto 2018/08/23 200.00iii `M5V 3T9 ... _ - �����,,,, Aldo DiBattista .............. .. ..... _. ....... � 301-195 King St.W. _ _...... Kitchener 2018/10/17 200.00, 200.00 2G 1B1 .........._ Nikolaos Liodakis ....... _ — ....... ___ 590 Royal Beech Dr. .. ... Waterloo 2018/10/05 150.00' 2T 23 __ .... ...._. Gardon McCague .....7 _._®..... _ Talbat St. .,,,,,,,. ,,,. ..... , , Kitchener 2018/10/04 150.00 N2M 2A8 .. ......._ ._...... __ ..... . _ ........ ✓ Additional information ....... is listed on separate supplementary attachment .. ... _. Total 2,700®0 9503P (2018/04) ..................... ., ............................................... Page 4 of 8 Amount $ Amount Returned to Name Full Address Date Receive( Received' $ Contributor 74 George St. Waterloo Deborah Wills N2J 1K7 18-08-02 $100.00 Margaret Walto- 42 Agens St. Kitchener Roberts N2G 2E8 18-08-08 $100.00 627 Rustic Dr. Waterloo Richard Walsh N 2 K 2Z5 18-08-08 $100.00 �41 Strange St. Kitchener Doug Suerich N2G 1P8 18-08-14 $100.00 1343 Queens Blvd. Margaret Hennig Kitchener N2M 106 18-08-14 $100.00' 461 Cabot Trail Oscar Cole-Arnal Waterloo N2K 4C8 18-08-24 $100.00 47 Peter St. Kitchener John McCutcheon N2G 3J7 18-09-10 $100.00 $'700.00 Table 2: Contributions in goods or services from individuals other than candidate or spouse (Note: must also be recorded as Expenses in Box C) 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) 2,700.00 1B Part III — Contributions from candidate or spouse Table 3: Contributions in goods or services 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 (yyyy/mm/dd) campaign Signs and stakes Fenton Signs 2010/01 /01 1200 Additional information is listed on separate supplementary attachment Total Current Market Value $ 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 L] Additional schedule(s) attached Description of fundraising event/activity Campaign Launch Date of event/activity (yyyy/mm/dd) 2018/08/02 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 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 9503P (2018/04) Page 7 of 8 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 Date (yyyy/mm/dd) Contact Information or single Name I Given Name(s) n hicence Number Address Suite/Unit No, Street No, I Street Name Municipality phone No. (including area code) 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 ........... _................ --- ___ _... . ................ 0, 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