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�-50ntario 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) 4 fI (?` to i /p JI <br /> Primary filing reflecting finances to December 31 (or 45"'day after voting day in a by-election) <br /> Supplementary filing including finances after December 31 (or 45"'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 ame(s) <br /> _ " l Aye,rjty, ��L s,o 11 <br /> Name of office for which the candidate sought election Ward name or no.(if any) <br /> Cgur i !'IOr- <br /> Name of Municipality <br /> Spending limit issu d by clerk <br /> $ J:z ,2no ' <br /> 10 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 /> a candidate in the municipality of <br /> �• J M 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 rk or commissioner) / <br /> in the 6�. ^/ ��l' K/r� 5 f/4-1- <br /> on(yyyy/mm/dd) 076 J <br /> Signature of Clerk or Commissioner ignature of Candidate <br /> Date Filed in the Clerk's Office(yyyy/mm/dd) <br /> 9503P(2013111) o Queen's Printer for Ontario,2013 Disponible an franple Pege 1 of 6 <br />
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