Laserfiche WebLink
tA 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 campaign period from(day candidate filed nomination) f _�;'o/ �- I p 1 I OA I to I �o 1 q— <br /> Primary filing reflecting finances to December 31 (or 45`h day after voting day in a by-election) <br /> ❑Supplementary filing including finances after December 31 (or 451h 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 /> rI �TL ,� W , `L_� <br /> Name of office for which the candidate sought election Ward name or no. (if any) <br /> L,`, nv �lCtLLo � <br /> Name of Municipality <br /> k l/JGsv t LLE <br /> Spending limit issued by clerk <br /> $ <br /> 1 -7 1 -7 40- $ 5� <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 /> I' W I L G Y Y -f, L'`" a candidate in the municipality of <br /> k / /V(r L' ! 4 L is , 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 /!}i✓:✓ �i'� fi i� � /�C L G <br /> on(yyyy/mm/dd) <br /> Signature of Clerk or Commissioner 0,04,rl e%4t; Si u�ndidate <br /> Date Filed in the Clerk's Office(yyyy/mm/dd) <br /> 9503P(2013111) 0 Queen's Printer for Ontario,2013 Disponible en franrais Page 1 of 8 <br />