-~ob. Standard Record-Keeping and Campaign Financing Disclosure Forms. Record-Keeping Forms. Campaign Financing Summary Forms.

Transcription

1 -~ob Standard Record-Keeping and Campaign Financing Disclosure Forms Record-Keeping Forms R.1: Record of Monetary Contributions Table R.1: Class of Contributors R.2: Record of n-kind {Discounted and Donated) Contributions Table R.1: Class of Contributors R.3: Record of Election Expenses Table R.2: Election Expense Classes R.4: Record of Anonymous Contributions Remitted to Local Government Campaign Financing Summary Forms Candidates: C.1: Cover Sheet and Checklist C.2: Declaration for Candidate and Financial Agedt j C.3: Campaign Financing Disclosure Summary Campaign Organizers/Elector Organizations: 0.1: Cover Sheet and Checklist 0.2: Declaration for Campaign Organizer/Elector Organization and Financial Agent 0.3: Campaign Financing Disclosure Summary Schedules A.1 -Summary of Campaign Contributions./ A.2- Campaign Contributors / B - Election Expenses / C - Surplus Funds Disbursement {Candidates)./ C- Surplus Funds Disbursement {Campaign Organizer and Elector Organization) M NSTRY Of COMMUNTY, SPO RT AND CULTURAL DEVELOPMENT - CAMPAGN f inancng STANDARD FORMS BOOK LET

2 Record-Keeping Forms Form R.1: Record of Monetary Contributions Table R.1: Class of Contributors 1. ndividual 2. Corporation/Business 3. Unincorporated Organization 4. Trade Union 5. Non-Profit Organization 6. Other Contributor M NSTRY OF COM M UN TY, SPO RT A ND CULTU RAL DEVELOPM ENT- CAMPAGN FNAN CNG STANDARD FORMS BOOKLET

3 Form R.4: Record of Anonymous Contributions Remitted to local Government DATE RECEVED (DD-MM-YY) CONTRBUTON VALUE DATE REMTTED Page _ of - Page Total Total Anonymous Contributions Remitted to Local Government M NSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT - CAMPAGN FNANCNG STA NDARD FORM S BOOKLET

4 Form C.1: Cover Sheet and Check List Election Campaign Financing Report.. CANDDATE PLEASE PRNT N BLOCK LETTERS... -z_vef<. KDl JVFJ-!'ilt!J1D : C,-1-f Ci;t;NC _..... )V D V 81( f;m_ 19, ;)O! /_ql!jo/ JR-j' t ; 7 36 Ffit tfilt4 t-s S1. 1 v15 3s9 e e.. JSD 1r;b?JJ-ttc, f> g:> 7s:f 3&'Zf This campaign financing report includes the following completed forms and schedules: /v/jn.;()/ )t a (g C.1: Cover Sheet and Check List ~ C.2 : Declaration for Candidate and Financial Agent gl C.3: Campaign Financing Disclosure Summary Schedules lz A.1: Summary of Campaign Contributions J A.2: Campaign Contributors ~ 8: Election Expenses D 500 late filing fee (if filed between March 20, 2012, and April 18, 2012) [X C: Surplus Funds Disbursement NOTE: Do not include record-keeping forms in the financial disclosure pages submitted to the designated local government officer. Record-keeping forms are for candidate, campaign organizer, elector organization and financial agent use only. Do not disclose additional information on disclosure forms (e.g. personal information not required by legislation)- even if it has been captured through t he record-keeping process. M NSTRY OF COMMUNTY, SPO RT A ND CULTURAL DEVELOPM ENT - CAMPAGN FNANCNG STANDARD FORMS BOOKLET

5 Form C.2: Declaration for Candidate and Financial Agent DECLARATON OF CANDDATE, _Ro!> -"'LJce_.[name of candidate], a candidate in the No. nat. m o [name of local government] election, solemnly affirm that to the best of my knowledge, information and belief: (a) this campaign financing disclosure statement and supporting schedules completely and accurately disclose the information required by section 90 of the Local Government Act (or section 62 of the Vancouver Charter) in relation to my election campaign for the office of to ~<A \to rna me of office] in the~\\ [yearj general local election for the ( L, oft-..)~mulw {n ame of local government]; and (b) the requirements of Part 3, Division 8 of the Local Government Act (or Part 1, Division 8 of the Vane uver Charter) have been met in relation to the election campaign in relation to my election campaign for the office of ' Lll'\. ol [name of office] in theqhi!_ [year] general local election for the~ of local government]; Solemnly affirmed before me at 0 ()j'a.pa.) ~, British Columbia this '3<} day o~~p \ '2- DECLARATON OF FNANCAL AGENT.!fA schedule and belief: ~[name of financial agent], have prepared this campaign financing disclosure statement and supporting Z-v~name of candidate] and solemnly affirm that to the best of my knowledge, information (a) this campaign financing disclosure statement and supporting schedules completely and accurately disclose the information required by se campaign of n 90 of the Local Government Act (or ses;tion 62 of :he Vancouver Charter) in relation to the election Z.Ve1l.Jname of candidate] for C()yrJ t 1 L!JflJname of office] in thejo// [year] general local election for the ) #f) gname of local government]; and (b) the requirements of Part 3, Division 8 of the Local Government Act (or Part 1, Division 8 of the Vancouver Charter) have been met in relation to the election campaign of oh 'Zvt7Z..rname of candj!jl~l for C!JurJ~ tll!j,(jname of office] in the.)oj [year] general local election for the L"fr(oPAJtJ?;t)'p[name of local government]. A -. u,.-... _L31'&t-~ Solemnly affirmed before me at fv'ff";v'j / r t v, British Columbia this -~- day of ~ Signature of Financial Agent MNSTRY Of COMMUNTY, SPORT AND CULTURAL DEVELOPMENT - CAM PAGN FNANCNG STA NDARD FORM S BOOKLET

6 Form C.3: Campaign Financing Disclosure Summary CAMPAGN FNANCNG DSCLOSURE STATEMENT FOR THE 2011 GENERAL LOCAL ELECTON Local Government Act [section 90] or Vancouver Charter [section 62] This campaign financing disclosure statement is to be filed with the designated officer of the [local government] within 120 days after general voting day on ~+4~~~~~~~ Nov mber 19, Th1s deadline is March 19, NAME OF CANDDATE NAME OF OFFCE for which the candidate sought election NAME OF ENDORSNG ELECTOR ORGANZATON (if i3ppiicable) SUMMARY OF CAMPAGN CONTRBUTONS Total amount of campaign contributions (Total from Schedule A.1) List of contributors who made contributions totalling 100 or more (See Schedule A.2) Total amount of anonymous campaign contributions remitted to the local government (Total Schedule A.2) ~--- SUMMARY OF ElECTON EXPENSES Total amount of election expenses (Total from Schedule B) List of election expenses by expense class (See Schedule B) SURPlUS FUNDS Transfer from local government (surplus funds from previous election).::lir Balance remaining in candidate's campaign account (See Schedule C for disbursement of surplus funds) CAMPAGN ACCOUNT NFORMATON All monetary contributions were deposi~ d in, and,r elec.~ip;yexpens.es paid from,. an account opened for this purpose at UJA5f4..-lbt{/flfi'Jocated at! /-5Cf tjijar. f c!m,7l{;j;";t:u }v;;:j 'e~c M NSTRY OF COMM UNTY, SPORT AND CU LTURAL DEVELOPM ENT - CAM PAGN FNANCNG STANDARD FORMS BOOKLET

7 Form 0.3: Campaign Financing Disclosure Summary CAMPAGN FNANCNG DSCLOSURE STATEMENT FOR THE 2011 GENERAL LOCAL ELECTON Local Government Act [section 90] or Vancouver Charter [section 62] This campaign financing disclosure statement is to be filed w ith the designated officer of the voting day on November 19, This deadline is March 19, [local government] w ithin 120 days after general NAME OF CAMPAGN ORGANZER/ELECTOR ORGANZATON NAME OF CANDDATE(S) ENDORSED/SUPPORTED (for Elector Organizations only). SUMMARY OF CAMPAGN CONTRBUTONS Total amount of campaign contributions (Total from Schedule A.1) List of contributors who made contributions totalling 1 00 or more (See Schedule A.2) Total amount of anonymous campaign contributions remitted to the local government (Total Schedule A.2) -'----- SUMMARY OF ELECTON EXPENSES Total amount of election expenses (Total from Schedule B) List of election expenses by expense class (See Schedule B) SURPLUS FUNDS Balance remaining in elector organization/campaign organizer campaign account See Schedule C for disbursement of surplus funds CAMPAGN ACCOUNT NFORMATON Al l monetary contributions were deposited in, and all election expenses paid from an account opened for this purpose at located at [name of financial institution] [branch address] MNSTRY OF COMMUNTY. SPORT AND CULTURAL DEVELOPM ENT - CAMPAG N FNANCNG STANDARD FORMS BOOKLET

8 Schedule A.1 - Summary of Campaign Contributions Contributions from known sources: Total value of contributions of 100 or more from a single source (unless nil, also complete schedule A.2) A 5/[1),... Total value of contributions of or less from a single source B ky Total number of contributions of or less from a single source Contributions from unknown (anonymous) sources: Total contributions from anonymous sources Less anonymous contributions remitted to local government Total amount of anonymous contributions of 50 or less c Total amount of contributions: y A+B+C Sc;CfJ, ' MNSTRY OF COMMUNTY. SPORT AND CULTURAL DEVELOPMENT - CAMPAGN FNANCNG STANDA RD FORMS BOOKLET

9 Schedule A.2 - Campaign Contributors 1. ndividuals (class 1) contributing 100 or more: 2. Organizations (classes 2, 3, 4, 5, 6) contributing 100 or more:.. :. Table R1 : Class of Contributors:.. 1. ndividual 2. Corporation/Business 3. Unincorporated Organization 4. Trade Union 5. Non-Profit Organization 6. Other Contributor 3. Anonymous contributions remitted to local government: DATE RECEVED (DD MM YY) CONTRBUTON VALUE DATE RE M TTED (DD MM YY) Total MNSTRY Of COMMUNTY. SPO RT AND CULTURAL DEVE LOPMENT - CAMPAGN FNANCNG STANDARD FORMS BOOKLET

10 Schedule B - Election Expenses A. Election campaign advertising for: 1) radio, television, newspaper, periodical or electronic advertising to the public 2) signs, pamphlets, flyers and brochures 3) advertising and promotion for the public not included in A.1 or A.2 above B. Election campaign office expenses for: 1) compensation paid to persons for campaign work, other than for services described in section 89(2) of the Local Government Act (or section 62 of the Vancouver Charter) 2) rent, insurance, utilities 3) courier services and postage 4) furniture and equipment 5) office supplies and other office expenses not covered by B-1 to B-4 above C. Convention and other similar meeting expenses: D. Expenses for campaign-related functions not described inc: E. Research and polling expenses: F. Campaign-related transportation: G. Other (provide description): 5?_Af lf1 e-;)~'(j fo e._ t-( 1 f!.ljl(_ -.r /?epu,.jd!7) -to S. C... ~ o, ))~-t-e 1.J} 2_D. " J ~-55' CooD..- J_fo3.. by tj{..)_'( ;)_(:/). Total amount of other expenses Total Amount of Election Expenses: M NSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPM ENT - CAMPAGN FNANCNG STANDARD FORMS BOOKLET

11 Schedule C - Surplus Funds Disbursement {Candidate) A. Balance remaining in account B. Amount reimbursed to candidate from campaign account for the candidate's contribution to their campaign C. Amount of remaining surplus funds (after any reimbursement under B) D. Details of the disbursement of remaining surplus funds under C: ;V, /)-.. Schedule C - Surplus Funds Disbursement {Campaign Organizer/ Elector Organization) A. Balance remaining in account B. Details of the disbursement of remaining surplus funds M NSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT - CAMPAGN FNANC NG STANDARD FORMS BOOKLET