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�l- Ontario Ministry of Municipal Affairs Financial Statement -Auditor's Report <br /> and Housing p <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 mpaign period from(day candidate filed nomination) `J 0 ®� (� to lU I&-7 <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 <br /> C `_S Given Name(s) <br /> Name of office which the candi t sought election Ward name or no. (if any) <br /> Name of Mun ipality <br /> :�_ JO P Ol 0 Y'7 <br /> Spending limit issued by clerk <br /> PK'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 /> t S a candidate in the municipality of <br /> d n at to the best of my knowledge and belief that these <br /> financial statements and attached pporting schedules are r and c rect. <br /> Declared before(clerk or commissioner) <br /> in the C, <br /> on(yyyy/mm/dd) 2-ai 5 f'0 ,Z. <br /> Signature of Clerk or Commissioner 6jature of Candidate <br /> Date Filed in the Clerk's Office(yyyy/mm/dd) <br /> 9503P(2013/11) 0 Queen's Printer for Ontario,2013 Disponible an frangais Page 1 of 8 <br />