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r <br /> r� <br /> tA "'Ontario Mlnlstry of Municipal Affairs Financial Statement -Auditor's Re <br /> and Housing port <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 DDYY MM DD <br /> For the campaign period from(day candidate filed nomination) I 0/•y I d�, I� 7 to � <br /> ❑ Primary filing reflecting finances to December 31 (or 451"day after voting day in a by-election) <br /> ❑Supplementary filing including finances after December 31 (or 45h 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 /> A,q TrE,R,S.9 V .G A R Z y <br /> Name of office for which the candidate sought election Ward name or no. (if any) <br /> Name of Municipality <br /> eu N OL <br /> Spending limit issued by clerk <br /> $ / 7 75-6. S',6-_ <br /> R 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' 1—,a n R y �ii77 Fh C G+,L/ a candidate in the municipality of <br /> "Z,? a -C A-1/ 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//mmldd) c•Z�fl•�S` 1-4 A-Z/ <br /> Signature of Clerk or Commissioner 47gn—ature o <br /> - 91 <br /> Date Filed in the Clerk's Office(yyyy/mm/dd) <br /> a <br /> 9503P(2013/11) m Queen's Printer for Ontario,2013 Disponible on frongais <br /> Page 1 of 8 <br />