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HomeMy WebLinkAboutFinancial Statement - Auditor's Report Third Party - Form 8O nta rio O Ministry of Municipal Affairs Financial Statement — and Housing Auditor's Report Third Party — Form 8 Municipal Elections Act, 1996 (Section 88.29) Instructions All registrants must complete Boxes A, B, C and D and Schedule 1. All registrants must complete Schedule 2 as appropriate. Registrants 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 registrant or, if the registrant is an individual, their spouse) shall be immediately paid to the clerk who was responsible for the conduct of the election. YYYY MM DD YYYY MM DD For the campaign period from to ❑ Initial filing reflecting finances from start of campaign to December 31 (or 45 days after voting day in a by-election) ❑ Supplementary filing reflecting finances from start of campaign to end of extended campaign period Box A: Name of Registrant Name of Registrant (individual, trade union or corporation) Official Representative (name of person signing on behalf of trade union or corporation) Last Name or Single Name Given Name(s) Municipality Spending Limit — General Spending Limit — Parties and Other Expressions of Appreciation Box B: Declaration I, , a registrant (or official representative), declare that to the best of my knowledge and belief that these financial statements and attached supporting schedules are true and correct. Signature of Registrant (or Official Representative) Date (yyyy/mm/dd) Date Filed (yyyy/mm/dd) Time Filed Initial of Registrant, Official Representative Signature of Clerk or Designate or Agent (if filed in person) 10552P (2022/04) © Queen's Printer for Ontario, 2022 Disponible en frangais Page 1 of 8 Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending institution INCOME Total amount of all contributions (from line 1A in Schedule 1) + $ Revenue from items $25 or less + $ Sign deposit refund + $ Revenue from fundraising events not deemed a contribution (from Part III of Schedule 2) + $ Interest earned by campaign bank account + $ Other (provide full details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ 6. + $ Total Campaign Income (Do not include loan) EXPENSES (Note: Include the value of contributions of goods and services) 1. Expenses subject to general spending limit Inventory from previous campaign used in this campaign (list details in Table 2 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. + $ 4. + $ 5. + $ 6. + $ Total Expenses subject to general spending limit = $ C2 2. Expenses subject to spending limit for parties and other expressions of appreciation 1. + $ Amount borrowed C1 10552P (2022/04) Page 2 of 8 2. + $ 3. + $ 4. + $ 5. + $ Total Expenses subject to spending limit for parties and other expressions of appreciation = $ C3 3. 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 + $ 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 registrant's disability (provide full details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Other (provide full details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Total Expenses not subject to spending limits = $ C4 Total Campaign Expenses (C2 + C3 + C4) _ $ C5 Box D: Calculation of Surplus or Deficit Excess (deficiency) of income over expenses (Income minus Total Expenses) (Cl — C5) + $ D1 If there is a surplus, deduct any refund of registrant's or spouse's contributions to the campaign — $ Surplus (or deficit) for the campaign = $ D2 If line D2 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. 10552P (2022/04) Page 3 of 8 Schedule 1 - Contributions Part I — Summary of Contributions Contributions in money from registrant and (if individual) spouse Contributions in goods and services from registrant and (if individual) spouse(include value listed in Table 1 and Table 2) 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 registrant or spouse). Total value of contributions exceeding $100 per contributor (from line 1 B; list details in Tables 3-6) • Include ticket revenue, contributions in money, goods and services where the total contribution from a contributor exceeds $100 (do not include contributions from registrant or spouse). Less: Ineligible 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) Part II — Contributions from registrant or spouse Table 1: Contributions in goods or services _ $ 1A Description of Goods or Services Date Received Value ($) (yyyy/mm/dd) Total ❑ Additional information is listed on separate supplementary attachment, if completed manually. Table 2: Inventory of campaign goods and materials from previous municipal campaign used in this campaign (Note: value must be recorded as a contribution from the registrant and as an expense. Description Date Acquired (yyyy/mm/dd) Supplier Quantity Current Market Value ($) Total ❑ Additional information is listed on separate supplementary attachment, if completed manually. Part III — Contributions exceeding $100 — contributors other than registrant or spouse 10552P (2022/04) Page 4 of 8 Table 3: Monetary contributions from individuals other than registrant or spouse Name Full Address Date Received (yyyy/mm/dd) Amount Received ($) Amount Returned to Contributor or Paid to Clerk ($) Amount Received ($) Amount Returned to Contributor or Paid to Clerk ($) Goods or Services (yyyy/mm/dd) to Contributor or Paid to Clerk ($) Total ❑ Additional information is listed on separate supplementary attachment, if completed manually. Table 4: Monetary contributions from corporations or trade unions Name (legal and carrying on business as) Full Address President or Business Manager Authorized Representative Date Received (yyyy/mm/dd) Amount Received ($) Amount Returned to Contributor or Paid to Clerk ($) Goods or Services (yyyy/mm/dd) to Contributor or Paid to Clerk ($) Total ❑ Additional information is listed on separate supplementary attachment, if completed manually. Table 5: Contributions in goods or services from individuals other than registrant or spouse (Note: Must also be recorded as Expenses in Box C.) Name Full Address Description of Date Received Value ($) Amount Returned Goods or Services (yyyy/mm/dd) to Contributor or Paid to Clerk ($) 10552P (2022/04) Page 5 of 8 Name Full Address Description of Goods or Services Date Received (yyyy/mm/dd) Value ($) Amount Returned to Contributor or Paid to Clerk ($) Value ($) Amount Returned to Contributor or Paid to Clerk ($) Total ❑ Additional information is listed on separate supplementary attachment, if completed manually. Table 6: Contributions in goods or services from corporations or trade unions (Note: Must also be recorded as Expenses in Box C.) Name (legal and carrying on business as) Full Address President or Business Manager Authorized Representative Description of Goods or Services Date Received (yyyy/mm/dd) Value ($) Amount Returned to Contributor or Paid to Clerk ($) Total ❑ Additional information is listed on separate supplementary attachment, if completed manually. Total for Part III (Add totals from Tables 3-6) (Record in Part 1 — Summary of Contributions) $ 1B 10552P (2022/04) Page 6 of 8 Schedule 2 — Fundraising Events and Activities Complete a separate schedule for each event or activity held. ❑ Additional schedule(s) attached, if completed manually. Fundraising Event/Activity 1 Description of fundraising event/activity Date of event/activity (yyyy/mm/dd) Part I — Ticket revenue Admission charge (per person) $ 2A (If there are a range of ticket prices, attach complete breakdown of all ticket sales) Number of tickets sold x 2B Total Part I (2A X 2B) (include in Part I of 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 (include in Part I of Schedule 1) Part III — Other revenue not deemed a contribution Provide details (e.g., contribution of $25 or less; goods or services sold) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Total Part III (include under Income in Box C) Part IV — Expenses related to fundraising event or activity Provide details 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Total Part IV Expenses (include under Expenses in Box C) M5 10552P (2022/04) Page 7 of 8 Auditor's Report Municipal Elections Act, 1996 (Section 88.25) A registrant who has received contributions or incurred expenses in excess of $10,000 must attach an auditor's report. Professional Designation of Auditor Municipality Date (yyyy/mm/dd) Contact Information Last Name or Single Name Given Name(s) Licence Number Address Suite/Unit Number Street Number Street Name Municipality Province Postal Code Telephone Number Email Address 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 88.29 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. 10552P (2022/04) Page 8 of 8