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raj <br /> �r- Ontario Ministry of Municipal Affairs Financial Statement - Auditor's Report <br /> and Housing <br /> s Form 4 <br /> Municipal Elections Act, 1996(Section 78) <br /> Instructions: <br /> All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses beyond the nomination fee <br /> must complete Boxes C, D, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in <br /> excess of$10,000 must also attach an Auditor's Report. <br /> All surplus funds(after any refund to the candidate or his or her spouse)shall be paid immediately over to the clerk who was responsible <br /> for the conduct of the election. <br /> yyyy MM DD yyyy MM DD <br /> For the campaign period from(day candidate filed nomination) 1 2 0 1 4 1 0 1 1 0 2 I to 12 0 1 41 1 11 2 6 <br /> k❑ Primary filing reflecting finances to December 31 (or 45th day after voting day in a by-election) <br /> ❑ Supplementary filing including finances after December 31 (or 45`h day after voting day in a by-election) <br /> Box A: Name of Candidate and Office <br /> Candidate's name as shown on the ballot <br /> Last Name Given Name(s) <br /> QUEEN GORD <br /> Name of office for which the candidate sought election Ward name or no. (if any) <br /> DEPUTY MAYOR <br /> Name of Municipality <br /> TOWN OF KINGSVILLE <br /> Spending limit issued by clerk <br /> $ 17.750.85 <br /> ❑ 1 did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and B only) <br /> Box B: Declaration <br /> I, GORD QUEEN a candidate in the municipality of <br /> KINGSVILLE hereby declare that to the best of my knowledge and belief that these <br /> financial statements and attached supporting schedules are true and correct. <br /> Declared bg(ore(clerk or commissioner) <br /> in the—' <br /> on (yyyy/mm/dd) <br /> r,r <br /> Signature of C or Commissioner kSigna6re of Candidate <br /> Date Filed in We CI rk's Office(yyyy/mm/dd) <br /> 9503P(2013/11) 0 Queen's Printer for Ontario,2013 Disponible en frangais Page 1 of 10 <br />