Ontario. /< -z._' Financial Statement - Auditor's Report Form 4 Municipal Elections Act, 1996 (Section 78)

Transcription

1 t ~ r ::> Ontario Ministry of Municipal Affairs and Housing Financial Statement - Auditor's Report Form 4 Municipal Elections Act, 1996 (Section 78) Instructions: Al candidates must complete Boxes A and B. Candidates who receive contributions orincurexpenses beyond the nomination fee must complete Boxes C, D, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or Incur expenses in excess or $10,000 must also attach en Auditor's Report. An surplus funds (after any refund to the candidate or his or her spouse) shal be paid immediately over to the clerk who was responsible for the conduct of the election. For the campaign period from (day candidate flied nomination) YYYY MM DD YYYY MM OD I 2 I 0 I 1 I 4 ' 0 I 1 I 0 I 8 I to -=I I o"--' 2... l_.. l 4~---- ' 1 l~ o ~'2~1~1 6 ~ Primary filing reftecling finances to December 31 (or 45"' day after voling day in a by-election) 0 Supplementary filing Including finances after December 31 (or day after voling day in a by-eleclion) Box A: Name of Candidate and Office Candidate's name as shown on the ballot Last Name Hammond Name oroffice for which the candidate sought election Mayor Name of Municipality Oshawa Spending limit issued by clerk s 100, Given Name(s) Dnn Ward name or no. (ifany) 0 I did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and 8 only) Box B: Declaration 1. Daniel S. Hammond , a candidate In the muni<:ipalily of Oshawa hereby declare that to the best or my knowledge and belief that these financial statements and atlached supporting schedules are true and correct Declared before (clerk or commissioner) in the Citv of Oshawa on (yyyy/mmldd) "'" 2-"-1s'"-1...;..3/-"'2'il'---...,...- o... 0""' ----,...---,.,, /< -z._' 201 5/ Date Filed in the Clerk's Office {yyyy/mm/dd) l Signature of Candidate 9503P ( Oueefl's Pnnter for Ontano Oisponibleen f~is Page 1ol8

2 Box C: Statement of Campaign Income and Expenses LOAN Name or bank or recognized lending lnslilutlon Amount borrowed _$~ INCOME Total amount or all contributions (From line 1A in Schedule 1) Refund of nomination filing fee Sign deposit refund Revenue from fund-raising events not deemed a contribution (From Part Ill of ti~~2) Interest earned by campaign bank account Other (provide full details) ~ 3. Total Campaign Income (Do not include loan) = $ 9, C1 EXPENSES (Nole: include lhe value of contributions or goods and services) Expenses subject to spending limit Nomination filing fee Inventory from previous campaign used 1n this campaign (list details in Table S of Schedule 1 ) Advertising Brochurestnyers Signs (including sign deposit) Meetings hosted Office expenses Incurred until voling day Phone andfof Internet expenses incurred until voling day Salaries, benefits, honorana, proressional fees incurred until voting day Bank charges incurred until voting day Interest charged on loan until voting day Other (provide full details) Total Expenses subject to spending limit = $ 9, C2 Expenses not subject to spending limit Accounting and audit Cost of fund-raising evenls/aclivilies (list detaus in Part IV of Schedule 2) Voling day party/appreciation nollces Office expenses incurred after voling day Phone and/or Internet expenses incurred after voting day Salaries, benefits, honoraria, professional fees lnamed after voting day + $ Bank charges incurred after voling day Interest charged on loan alter voting day Expenses related to recount Expenses related to controverted electlon Expenses related to compliance audit Expenses related lo candidate's disability (provide lull detaijs) Other (provide full detaws) ~--~ ~-- 3. ~ Total Expenses not subject to spending limit $ C3 = Total Campaign Expenses (C2 + C3) = $ 9, C4 9503P ( ) Pagto 2 of 8

3 Box D: Calculation of Surplus or Deficit Excess (deficiency) of income over expenses (Income - Total Expenses) (C1 - C4) Eligible deficit carried forward by the candidate from the last eteclion _$ 02 Total (01-02) $ Ifthere is a surplus, deduct any refund of candidate's or spouse's contributions to the camp11ign Surplus (or deficit) for the campaign = _s.o $...m If line 03 shows a surplus, the amount must be paid m trust, al lhe time the financial statements are filed, lo the municipal derk who was responsible for the conduct of the election. Amount of$ paid to municipal derk in the municipality of P (2013/11) Page 3 of8

4 Schedule 1 - Contributions Part 1-Summary of Contributions Contribution from candidate (include the value of Inventory listed in Table 5) Cootnbulion from spouse Tolal value of contributions not exceeding $100 per contributor Include ticket revenue, contributions in money, goods and services where the lolal contribution from a contributor is S100 or less (do not Include contributions from candidate or spouse). + _$.;... Total value of contributions exceeding $100 per contributor (from line 18; list details in Tables 1-4) Include ticket revenue. contributions in money, goods and services where the total contribution from a cootributor exceeds $100 (do not include contributions from candidate or spouse). + _$' Less: Contributions returned or payable to the contributor $ Contributions paid or payable to the clerl<, including contributions from anonymous sources exceeding S10 $ Total Amount of Contributions (Record in Box C) = $ A Part 11- Ust of Contributions from Each Single Contributor Totalllng more than $100 Tabl e 1 : M oneta!}'. con trlb utlons from lndlvldua Is other than candidate or snouse Name Full Address Amount$ - 0 Additional infonnatlon Is listed on separate supplementary attachment Total.Jable 2: Moneta contributions from co rations or unions Name (Legal and Carrying on Full Address President or Business Authorized Amounts Business As) Manager Representative 9503?( I Page4or8

5 --- 0 Additional infonnatlon is listed on separate supplementary attachment Total Table 3: Contributions In goods or services from Individuals other than candidate or spouse 'Note: must also be recorded as exoenses In Box C) Name Full Address Description ofgoods or Value$ Services Additional infoonation Is listed on separate supplementary attachment Totaf 9503? ( ) Pages of a

6 Table 4: Contributions In aoods or services from con>0ratlons or unions INote: must also be recorded as exoenses In Box qj_ Name of Full Address President or Authorized Description of Value S Corporatlon(Legal and Business Manager Reprnentatlve Goods or Services Carrvmo on Business As) -- -,._ - Total Part II Contributions (Add Totals from Tables 1-4)(Record In Part 1-Summary) $ 18 0 Additional information is listed on separate supplementary attachment Total Part Ill - Inventory Table 5: Inventory ofcampaign Goods and Materials from Pf"evlous Campaign used In this Campaign INote: value must be recorded as a contribution from the candidate and as an exrntnsel Description Date Acquired Supplier Current Market Quantity Total Value$ (yyyy/mm/dd) Value $ 0 Additional information is tisted on separate supplementary altachment Total 9503P ( ) Page 6of8