Laserfiche WebLink
�r- Ontario Ministry of Municipal Affairs Financial Statement - Auditor's Report <br /> and Housing <br /> 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) I do%7 O 3 2 8 to 1 /0 27 <br /> [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 45th 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 /> 01 C)6.5 t n Core. <br /> Name of office for which the candidate sought election Ward name or no. (i ny) <br /> C0w)CA eV- <br /> Name of Municipality <br /> W h o p KI Liq 6 vr 1�� <br /> Spending limit issued by clerk <br /> ❑ I 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, a candidate in the municipality of <br /> h�V , '�e 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 before(clerk or commissioner) <br /> in the <br /> on (yyyy/mm/dd) �/i_7 <br /> Signature of Clerk or Commissioner Signature of Candidate <br /> Date Filed in the Clerk's Office(yyyy/mm/dd) <br /> 9503P(2013/11) ©Queen's Printer for Ontario,2013 Disponible en franrais Page 1 of 8 <br />