FORM 4 REFERENCE : SECTION 21(1)

Transcription

1 REFERENCE : SECTION 21(1) FORM 4 CAMPAIGN EXPENSES AND CONTRIBUTIONS BY-LAW NO. 10/2010 THE CITY OF WINNIPEG Campaign Period Surplus (Deficit) ((A) - (B)) $ 64 / Total Period Expenses $ (B) S (A) Total Campaign Income (as per Statement of Income and Expenses) Campaign Expenses Subject to Limitation $ 24444,/ $ Campaign Expense Limitation (as per form 3) SUMMARY OF CAMPAIGN INCOME AND EXPENSES COUNCILLOR DANIEL MCINTYRE OFFICE WARD NAME (IF COUNCILLOR CANDIDATE) ADDRE FAX NUMBER PHONF ALTERNATE CITY, PROVINCE: WINNIPEG MB POSTAL CODE ADDRESS NAME OF REGISTERED CANDIDATE: CINDY GILROY NAME OF CANDIDATE AND OFFICE 30-Jun Mar-15 For the campaign period From To AUDITED FINANCIAL STATEMENT Audited Financial Statement - 1 of 14 4

2 Name of Candidate CINDY GILROY hereby declare that DECLARATION OF CANDIDATE Signature of Campaign Expenses and Contributions Officer Signature of Official A / day of %%Z Declared before me at the City of Winnipeg in the Province of Manitoba this as if made under oath. and correct and I make this declaration conscientiously believing it to be true and knowing that it is of the same force and effect declare that to the best of my knowledge and belief this Financial Statement and supporting schedules as set out herein are true Name of Candidate and supporting schedules as set out herein for CINDY GILROY and hereby Name of Official Agent VALERIE GILROY have prepared this Campaign Period Return DECLARATION OF OFFICIAL AGENT Signture of Campaign Expenses and Contributions Officer ignature of Candke -thl /34 day of,4y-2y 1 Declared before me at the City of Winnipeg in the Province of Manitoba this I make this declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath. to the best of my knowledge and belief this financial statement and supporting schedules as set out herein are true and correct and By-law No. 10/2010 Form 4-Audited Financial Statement - 2 of 14

3 Released by the Senior Election Official Candidates Surplus from immediately preceding Election $ INCOME FROM 30-Jun-14 TO 31-Mar-15 STATEMENT OF INCOME AND EXPENSES 3 of 14 SUB-TOTAL CAMPAIGN EXPENSES SUBJECT TO LIMITATION $ Campaign assistane including english translation to Tagalog - $1000 Insurance and Utilities $ 540 Website - $500 Furniture $ Stationery $ 852 Other (Please Specify): $ 1500 Bank Charges $ 51 Travel $ Telephone $ 709 Brochures $ 7490 Salaries and Benefits $ Signs $ 3443 Postage $ 2980 Office Rent $ 1500 Office Supplies $ 435 Meetings, Social Functions, Rallies $ 19 Advertising $ 4925 CAMPAIGN EXPENSES SUBJECT TO LIMITATION (ATTACH SCHEDULE 4; IF ANY DISPUTED CLAIMS, ATTACH SCHEDULE 5) EXPENSES Candidate s Personal Expenses $ TOTAL INCOME $ Interest Income $ Fund-Raising Event (attached Schedule 2) $ Other (Please Specify): $ Contributions (attached Schedule 1) $ By- aw No. 10/2010 Form 4 - Statement of Income and Expenses -

4 CAMPAIGN EXPENSES EXCLUDED FROM LIMITATION Sub-total Campaign Expenses Subject to Limitation $ $ STATEMENT OF INCOME AND EXPENSES (continued) Statement of Income and Expenses - 4 of 14 CAMPAIGN PERIOD SURPLUS (DEFICIT) TOTAL PERIOD EXPENSES SUB-TOTAL CAMPAIGN EXPENSES EXCLUDED FROM LIMITATION Recount Interest on Loans Expense in holding a Fund-Raising Function The Municipal Councils and School Boards Elections Act Court action commenced under Part 9, Accounting and Audit Total Income (reported from previous page) $ $ $ $ $ 565 $ 565 $ 64 V $ 25009

5 Returned Returned CONTRIBUTIONS PART I FOR USE BY MAYORALTY CANDIDATES ONLY (Section 8(2)(a)) SCHEDULE I - FOR MAYORALTY CANDIDATES ONLY 5 of 14 TOTAL TO BE PAID TO THE SENIOR ELECTION OFFICIAL $ o Cash and/or Goods and Services in excess of limits $ From anonymous sources $ CONTRIBUTIONS TO BE PAID TO THE SENIOR ELECTION OFFICIAL Excess cash over $ Excess over $1500 in the form of Goods and Services - to the Contributor $ to the Contributor $ CONTRIBUTIONS IN EXCESS OF LIMITS TOTAL CONTRIBUTIONS $ 0 Total of single source contributions of $250 or less $ From candidate $ a single source of more than $250 (complete Part II) Total of contributions in the Form of Goods and Services from $ From a single source totalling more than $250 (complete Part Ill) $ Schedule 1 Mayor -

6 Itemized list: List of Contributions in the Form of Goods and Services PART II Total (sum to equal 0 above) $ o Sub-total from supplementary list if used $ Nature of Goods and Services Supplier Value SCHEDULE I - FOR MAYORALTY CANDIDATES ONLY (continued) By-law No. 10/2010 Form 4- Schedule 1 Mayor - 6 of 14

7 Name Address Value List of Contributors from Single Source totalling more than $250 PART Ill SCHEDULE I - FOR MAYORALTY CANDIDATES ONLY (continued) TOTAL $ 0 Schedule 1 Mayor - 7 of 14

8 Returned PART I CONTRIBUTIONS FOR USE BY COUNCILLOR CANDIDATES ONLY (Section 8(2)(b)) SCHEDULE I - FOR COUNCILLOR CANDIDATES ONLY TOTAL TO BE PAID TO THE SENIOR ELECTION OFFICIAL $ 0 Cash and/or Goods and Services in excess of limits $ From anonymous sources $ CONTRIBUTIONS TO BE PAID TO THE SENIOR ELECTION OFFICIAL Excess over $750 in the form of Goods and Services - Excess cash over $750 - Returned to the Contributor $ to the Contributor $ CONTRIBUTIONS IN EXCESS OF LIMITS TOTAL CONTRIBUTIONS $ From candidate $ 750 i/ Total of single source contributions of $250 or less $ 7223 a single source of more than $250 (complete Part Il) Total of contributions in the Form of Goods and Services from $ From a single source totalling more than $250 (complete Part Ill) $ Schedule 1 CounciHor - 8 of 14

9 Itemized list: List of Contributions in the Form of Goods and Services PART II SCHEDULE I - FOR COUNCILLOR CANDIDATES ONLY (continued) Total (sum to equal D above) $ 0 Sub-total from supplementary list if used $ SEE ATTACHED LIST Nature of Goods and Services Supplier Value By-law No. 10/2010 Form 4-Schedule 1 Councillor - 9 of 14

10 CINDY GILROY LAST NAME FIRST NAME ADDRESS CITY PROV POSTAL CODE AMOUNT FROM CINDY RECEIPT RECEIPT List of Contributors from Single Source totalling more than $250 PART Ill 17, Borger Ralph Chrusch Curtis Cianflone Jerry Desilets Richard Shaw Betty Taylor Kathleen Bergman Doug Panchhi Apee Rajotte Cam Munro Colleen Cueto Rob Anderson Rose Ghuman Guriobal Ranville Elaine Halliday Del Lieverse Amanda Harvey Daryl Chief Melanie Cueto Rommel Cueto Rosarlo El Tassi Abdo Parke Wade Cunnington Cathy Gilroy Wendy Watson William C, Watson Dianna Gilroy Pearleen Gilroy Ernie Gilroy Cindy Gilroy Valerie 750,00 Gibson Susan Gilroy-Rajotte Pam 750,00 Hardy Judy SCHEDULE 1- FOR COUNCILLOR CANDIDATES ONLY By-Law No. 10)2010 Form 4- Schedule 1 Councillor

11 Name Address Value List of Contributors from Single Source totalling more than $250 PART Ill SCHEDULE I - FOR COUNCILLOR CANDIDATES ONLY (continued) TOTAL $ 0 Schedule 1 Councillor - 10 of 14

12 Date: NOT APPLICABLE FUND RAISING EVENTS INCOME STATEMENT (ATTACH A DIFFERENT SCHEDULE FOR EACH EVENT HELD) FUND RAISING FUNCTION SCHEDULE 2 11 of 14 If admission charge per person is not consistent, please provide complete breakdown of all ticket sales. * TOTAL GROSS REVENUE: $ 0 Other Revenue (Please Specify): $ REVENUE FROM FUNCTION (AX B) $ Number of Tickets sold $ B *Admission Charge (per person) $ A Type of Function: Held at: Schedule 2 -

13 Address: Name of financial institution: NOT APPLICABLE BORROWINGS, OVERDRAFT, ETC. SCHEDULE 3 Schedule 3 - Name Address GUARANTORS (attach supplementary list if space insufficient) Terms of repayment: Interest rate: Principal Amount of Loan: $ Guarantee Amount of 12 of 14

14 expenses amount STATEMENT OF DISPUTED CLAIMS included in Disputed Imount (ATTACH LIST IF MORE SPACE REQUIRED) SCHEDULE 4 13 of 14 TOTALDISPUTEDCLAIMS $ 0 $ 0 TOTAL FROM SUPPLEMENTARY LIST ATTACHED $ $ Reason for Dispute Nature of Expense Name & Address of Claimant $ $ Reason for Dispute Nature of Expense Name & Address of Claimant $ $ Reason for Dispute Nature of Expense NOT APPICABLE Name & Address of Claimant $ $ ByIawNo. 10/2010 Form 4 - Schedu)e 4 -

15 Winnipeg, MB R3G 0R4 Fax (204) Auditors Report - 14 of 14 delhalliday@mts.net Portage Avenue Telephone (204) Feb-15 / Date Signaturelf Auditor information contained in the accounting records on which the statements are based in accordance with prescribed accounting treatment. satisfy myself/ourselves as to the completeness of the records as described in the preceding paragraph, these statements present fairly the In my/our opinion, except for the effect of adjustments, if any, which I/we might have determined to be necessary had I/we been able to adjustments might be necessary to receipts and disbursements. that the accounting records include all donations of goods and services, receipts and disbursements for the campaign period. Accordingly, records of the candidate, in accordance with established accounting procedures and I/we was/were not able to determine whether any Due to the nature of the types of transactions inherent in an election campaign, it is impracticable through auditing procedures to determine my/our verification of these transactions was limited to ensuring that the financial statements reflect the amounts recorded in the accounting and other procedures as I/we consider necessary in the circumstances except as explained in the following paragraph. examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes such test perform an audit to obtain responsible assurance whether the financial statements are free of material misstatement. An audit includes My/our examination was made in accordance with generally accepted auditing standards. Those standards require that I/we plan and on these financial statements based on my/our audit. These financial statements are the responsibility of the registered candidate and official agent. My/our responsibility is to express an opinion for complying with By-law No. 10/2010 of The City of Winnipeg Charter. The statements are not intended to be and should not be used by accounting principles, are solely for the information and use of the Campaign Expenses and Contributions Officer for the City of Winnipeg anyone other than the specified users or for any other purposes. These statements, which have not been and were not intended to be, prepared in accordance with Canadian generally accepted Date Campaign Period Ended Date of Election 31-Mar-15 relating to the election held on 22-Oct-14 Name of Candidate candidate, for the campaign period ending CINDY GILROY I / we have examined the statements of assets and liabilities and income and expenses of Ward Name (if councillor candidate) DANIEL MCINTYRE Office COUNCILLOR Official Agent VALEFIE GILPOY Name of Candidate CINDY GILROY REFERENCE: SECTION 21(1) AUDITOR S REPORT Certified Management Accountant Inc. Tom Tasker, CA Del Halliday Del Halliday, CMA