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s <br /> k <br /> r , <br /> Minlstry of Municipal Affairs Financial State r <br /> Ontario and Housing ment -Auditor s Report <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 DO YYYY mm DO <br /> For the campaign period from(day candidate filed nomination) 2-0 1 1 $ to A <br /> Primary filing reflecting finances to December 31 (or 450,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 /> ;j-uU <br /> ll -�. <br /> Name of office for which the candidate sought election 1Narti name or no (if any) µ„ <br /> C7 E��DS 3 D rn�m bey— ( l s-��� ' 1 o w n o f ss�x �"o n o�' K 1 ri S 01, <br /> Name of Municipality <br /> �..�... µ... ......_... <br /> TDwii,ij of-- ESSe�x DF- K( p� &S \/1 Lj_6 <br /> Spending limit issued by clerk <br /> ..e_ .............. <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 /> ... _.� ... <br /> I. 0LI A- 5 U K C S a candidate in the municipality of <br /> 14,1 N &5 1 l.l,e & SS �� 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 Al I//S t0/%-t_.e <br /> on(yyyy/mmldd) 1,2 D /5 0' 3_ 7 <br /> Signature of Clerk or Commissioner _Signature andidate <br /> ' -7 <br /> Date Filed in the Clerk's Ice(yyyylmm/dd) <br /> 9503P(2013/11) 0 Queen's Printer for Ontario,2013 Disponible an franpa Page 1 of a <br />
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