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�l- Ontario Ministry of Municipal Affairs t ' <br /> Financial Statement - Auditors 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$10,000 must also attach an Auditor's Report. <br /> All surplus funds(after any refund to the candidate or his or her spouse)shall be paid immediately over to the clerk who was responsible <br /> for the conduct of the election. <br /> YYYY MM DD YYYY DD <br /> For the campaign period from(day candidate filed nomination) I a O l y I O$'I /.?I to oZd iy l �I <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 /> ff (n S T'A-1 O N Given Name(s) <br /> Name of office for which the candidate sought election Ward name or no. (if any) <br /> C d 0 N C. <br /> Name of Municipality <br /> l-� Ing &S v/ Z- 4. 6- <br /> Spending limit issued b clerk <br /> $ )� Ise .3 ? <br /> 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 /> a candidate in the municipality of <br /> /�'/`16 5 J//LC6 , 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 /0��!! �l^ l Jlrie <br /> on (YYYY/mm/dd) �� I <br /> Signature of Clerk or o i er j4tture of Candidate <br /> -� it � 1. <br /> Date Filed i the Clerk's Office(yyyy/mm/dd) <br /> 9503P(2013/11) O Queen's Printer for Ontario,2013 Disponible en frani;ais <br /> Page 1 of 8 <br />
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