R.L. (Dick) Goens
R.L. (Dick) Goens
3/30/2015 3:53:58 PM
10/13/2016 3:22:32 PM
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t .. <br /> r <br /> i�- Ontario Ministry of Municipal Affairs, Financial Statement -Auditor's Report <br /> and Housing p <br /> Form 4 <br /> Municipal Elections Act, 9996(Section 78) <br /> instructions: <br /> All candidates must complete Boxes A and 8, 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 DD <br /> For the campaign period from(day candidate filed nomination) C) to <br /> � Pnmary filing reflecting finances to December 31 (or 45'r"day after voting day in a by-election) <br /> i.] Supplementary filing including finances after December 31 (or 451^day after voting day in a by-election) <br /> Box A:Name of Candidate and Office <br /> Candidate's name as shown on the baAot � — • - ----- - <br /> Last Name � � I Given Name( / <br /> Name of office for which the candidate sought election — Ward name or no (if any) <br /> --. Cunl'itr��ality <br /> el, <br /> Name of <br /> Spending limit issued by clerk <br /> j 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, _fLl a candidate in the municipality of <br /> __.- _ 1_!✓C. i /�L _. --_ _ 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(cler or commissioner) <br /> in the <br /> on /mmldd 7 <br /> a: <br /> Signature Clerk or Commissioner -- — d' — ---- ---- <br /> Srg�l3WFe of Candidate <br /> Date Filed in the Clerk's officie(yyyy/mrn/dd) <br /> 9503P(2013111) 0Oueen's Printer for Ontario,2013 Disponible an franra.s Page 1 of 6 <br />
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