Auditor's Report - City of Pickering
Auditor's Report - City of Pickering
Auditor's Report - City of Pickering
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I<br />
enaud<br />
utland<br />
CHARTERED ACCOUNTANTS<br />
AUDITOR S REPORT<br />
TO<br />
Maurice Brenner<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition<br />
Assets <strong>of</strong> Surplus<br />
and Liabilities <strong>of</strong> Maurice and<br />
Brenner candidate for the campaign period <strong>of</strong> January 4 2010 to<br />
December 31 2010 for the election held on October 25 2010 These financial statements are the<br />
responsibility <strong>of</strong> Maurice Brenner candidate Our responsibility is to express an opinion<br />
financial statements based upon our audit<br />
on these<br />
Except as explained in the following paragraph we conducted our audit in accordance with Canadian<br />
generally<br />
1 accepted auditing standards Those standards require that we plan and perform an audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
examining on a test basis evidence supporting the amounts and disclosures in the financial statement An<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as<br />
evaluating the overall presentation <strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations and <strong>of</strong> goods and services<br />
receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring<br />
the financial the<br />
statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our<br />
opinion except for the effect <strong>of</strong> any adjustments if any which we<br />
might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial<br />
<strong>of</strong> position<br />
the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from January 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus<br />
and the<br />
deficit<br />
disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not<br />
require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 12 2011<br />
Marc A Renaud<br />
Edward Rutland<br />
307 High Street Whitby Ontario LIN 51 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario LIV 4N7<br />
Tel 905 666 2720 Fax 666 905 1042 Tel905 3023 509 Fax 905 6895 509<br />
maic@ienaudrutIand com<br />
ed @renaudrutland com
Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor s <strong>Report</strong><br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 4 to 2010 12 31<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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name<br />
Brenner<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
711 Sunbird Trail<br />
First Name<br />
Maurice<br />
I<br />
Middle Initial<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong><br />
On L 1 X2X5<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 831 8030 maurice<br />
brenner@rogers com<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Mayor<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 61 843 05<br />
2 Surplus or deficit from previous election 4835 20<br />
3 Total contributions received from Schedule 1 18 423 25<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 58 235 37<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 800<br />
6 Total <strong>of</strong> all campaign expenses from Box C f 59 035 37<br />
7 Election campaign surplus<br />
deficit from current election from Box E 35 776 61<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
Is<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 04 2010 12 31 Maurice Brenner<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 4835 20<br />
25<br />
Contributions from candidate 7223<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 11 200<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income 23 258 76 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 20 743 42<br />
Bank charges<br />
Brochures 25 054 58<br />
Interest on loan<br />
Inventory contributed to candidate campaign Schedule 3 960 00<br />
Meetings hosted 65 00<br />
Nomination filing fee 200<br />
Office expenses<br />
Phone and or Internet<br />
031<br />
750 00<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 6406 28<br />
Other provide full details<br />
1 Truck Rental Enterprise 1892 09<br />
2 Web Site 2164 00<br />
3<br />
C2<br />
Subtotal 58 235 37<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 800<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 800<br />
C3<br />
Total Campaign Period Expenses C2 C3 Is 59 035 37 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 35 776 61<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4 4087 25<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Fs 4087 25<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 34 976 61<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities Is 34 976 61<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 34 976 61 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
00 E2<br />
Surplus or deficit for the campaign period E1 E2 34 976 61<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination 34 976 61 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
fCGtC<br />
Box F Declaration<br />
I Maurice Brenner<br />
a candidate in the municipality <strong>of</strong><br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
CAU o C C2P t1 J<br />
on<br />
yyyy mm dd ad l1 p3 S<br />
Signature<br />
<strong>of</strong> Clerk or Commissioner<br />
Signature<br />
aot O 3 1 15<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
<strong>of</strong> Candidate<br />
USA DIANNE HARKER<br />
Canmissioneretc R4onal<br />
Nlunidpaliry<br />
<strong>of</strong>Ddrham forThe Corporation <strong>of</strong> the<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
xpires January 28 2012<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 7223 25<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
and services where value is 100 or less<br />
include all goods<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
11200<br />
Less<br />
Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 18 423 25<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A 113<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Susan Steele 966 Timmins Gardens <strong>Pickering</strong> L1 W212 100<br />
David Steele 966 Timmins Gardens <strong>Pickering</strong> L1 W212 150 00<br />
Ada Degasperis<br />
270 Chrislea Road Woodbrige L4L8A8 750 00<br />
Hyacinth Niles 44 1295 Wharf Street <strong>Pickering</strong> L1 WIA2 100<br />
Guery R Goya<br />
70 Kokanee Ct Maple L6A2V8 500<br />
Fred Reisman 4800 Sheppard Ave E Toronto M 1 S4N5 750 00<br />
Eileen Higdon<br />
852 Fairview Ave <strong>Pickering</strong> L1 W 1 M8 200<br />
Vidja Sagar Aggarwal<br />
30 Malta Ave Brampton L6Y4S5 400<br />
Additional information is listed on separate supplementary attachment Total 2950 00<br />
9503P 2010101 Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Box Grove Hill 270 Chrislea Road Woodbridge<br />
Silvio Degasperis Silvio Degasperis 750 00<br />
Developments Inc L4L8A4<br />
Pineneedle Developments<br />
Ltd<br />
23 Lesmill Road Suite 11 l<br />
Toronto M3B3P6<br />
David Brand David Brand 400<br />
Louisvill Homes Ltd I 1 Colonel Tr<br />
Toronto M 1 C 1 P8<br />
Nick Lazaridis Nick Lazaridis 750 00<br />
Alfin Financial Corp<br />
44 Upjohn Road Terry<br />
Toronto M3B2W 1<br />
Tsianos Nick Skentzos 500<br />
Carpenters Local 397 459 Cr<strong>of</strong>t St<br />
Trade Union Promotion PO Box 27 Joel Neville Joel Neville 300<br />
Fund<br />
Port Hope Ll A3V9<br />
Bench Press Ltd<br />
2402 Stouffville Road<br />
00<br />
OA Creative Outdoor PO Box 245 David Gray David Gray<br />
500<br />
Advertising Gormley<br />
LOH 1 GO<br />
Dentistry on Liverpool<br />
927 Liverpool Rd Steve Wiener Steve Wiener 250 00<br />
<strong>Pickering</strong> Ll W I S7<br />
Additional information is listed on separate supplementary attachment Total<br />
7500<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Century 21 Briscoe 950 Merritton Road BasementOffice 750 00<br />
Estate Ltd <strong>Pickering</strong> Ll V 1 B I for 1 Month<br />
Additional information is listed on separate supplementary attachment Total 750 00<br />
Total Part II Contributions<br />
11 200<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Supplementary Attachment<br />
Monetary Contributions from Unions or Corporations<br />
and Address President Business Cheque<br />
Name legal<br />
Carrying business as Manager Signatory<br />
Amount<br />
Pentad Construction Ltd 69 Healey<br />
Bolton Ontario<br />
L7E5A6<br />
Road 750 00<br />
Bitondo s Market Limited RR NO Lenard Bitonodo Lenard 500<br />
Locust Hill Ontario<br />
Bitondo<br />
LOH1J0<br />
John Giannakopoluos Ltd 550 Kingston Road John Giannakopoulos John 500<br />
OA Marathon Service Ajax L1T3A2 Giannakopoulos<br />
Station<br />
Brennan Paving and PO Box 3459 Leo McArthur Leo A 200<br />
Construction Markham McArthur<br />
Industrial Park PO<br />
Markham L3R6G7<br />
Don Mills Golf Centre PO Box 4080 Leo McArthur Leo A 200<br />
Markham<br />
Industrial Park PO<br />
Markham L3R9R8<br />
McArthur<br />
2229009 Ontario Inc 300 Kingston Road Sunil Solanki Sunil Solanki 500<br />
OA Altona Physiotherapy Unit 12<br />
and Chiopractric<br />
<strong>Pickering</strong> L 1 V6Z9<br />
Bayfield Realty Advisors Inc 2300 Yonge Street Harold Spring 500<br />
904<br />
Toronto M4P 1 E4<br />
International Brotherhood <strong>of</strong> 380 Lake Road Terry Dorgan Terry Dorgan 400<br />
Electrical Workers Local Unit 3<br />
894 Bowmanville<br />
L1C4P8<br />
Zodiac Landev 7501 Keele Street Attilio Lio Attilio Lio 500<br />
Management Inc Suite 401<br />
Vaughan<br />
L4K 1 Y2<br />
Total 4050
Schedule 2<br />
Fund Raising Function<br />
Q Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
I<br />
2A<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Is<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
j<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyy mm dd<br />
Schedule 3<br />
2X8 Signs 2003 10 01 Danco 00 19 40 760 00<br />
20 Frame Sets 01 2003 10 Maurice Brenner 10 00 20 200<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 960 00<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
ymm dd<br />
2X8 Signs 2003 10 01 Danco 19 00 40 760 00<br />
Rebar 30 2010 09 15 Buckley 200 30 60 00<br />
Rebar 320 2010 09 15 Buckley 400 320 1514 00<br />
Magnet Signs 2010 09 15 Printfast 50 00 6 300<br />
Coro Signs 2010 09 15 Printfast 619 175 1083 25<br />
Coro H Signs 2010 09 15 Printfast 365 200 730 00<br />
A Frames 2003 10 01 Maurice Brenner 10 00 20 200<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 4647 25<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
<strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Municipality<br />
Date yyyy mm dd<br />
<strong>Pickering</strong> 2011 03 12<br />
Contact Person<br />
Last Name<br />
Rutland<br />
Address<br />
Suite Unit No Street No Street Name<br />
1024 Rouge Valley Drive<br />
First Name<br />
Edward<br />
Licence No<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
<strong>Pickering</strong> ON L 1 V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
666 905 2720 ext 905 666<br />
1042 ED@RENAUDRUTLAND COM<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
Ontario and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong> 10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination a0 1 O oct l o<br />
to ao 10 a 3<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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Na If enV r w<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
5 5 Ar<br />
<strong>City</strong> Town Province Postal Code<br />
Pi crvV 0 L1W 11<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
3 33 6 509 7 70 r ro COm<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Ward Name or No if any<br />
Name <strong>of</strong> Municipal<br />
r<br />
u O Q elf rc<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was<br />
61 8 H 3 O 5<br />
2 Surplus or deficit from previous election o<br />
3 Total contributions received from Schedule 1 369 50<br />
4<br />
My total campaign expenses that were subject to the spending limit were from Box C 727 q8 I<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is or<br />
6 Total <strong>of</strong> all campaign expenses from Box C a L 8<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en fran ais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
ao 09 t ao a 3 Krrh W 1vas1<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Aer<br />
Q<br />
f<br />
4af<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
Is368<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
50 C1<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee<br />
aDd OCR<br />
Office expenses<br />
t<br />
Phone and or Internet<br />
6 w4<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2 C3 7 a77<br />
C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4<br />
C3<br />
9503P 2010101<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule a<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination<strong>of</strong> SUrplus or Deficit and Disposition <strong>of</strong> Surplus<br />
PartIDetermination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E2<br />
I<br />
E1<br />
E2<br />
E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I<br />
Kr nr<br />
1 Gk r yea<br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
Cku ct PiC K<br />
on<br />
yyyy mm dd C l f I r<br />
Signature <strong>of</strong> Clerk or Commissioner Signature andidate<br />
y<br />
dd<br />
Date Filed in the Clerk s Office yyyyAm<br />
DEBBIE M SHIEtOS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 12<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1 Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
o<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
38 TO<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 368 60<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
I1<br />
20<br />
Additional information is listed on separate supplementary attachment Total<br />
8 5<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
I<br />
I<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
FI Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2 Fund Raising Function<br />
0 Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold 1<br />
26<br />
2A<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 26 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Is<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign<br />
Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8 J
I<br />
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010101<br />
Page 8 <strong>of</strong> 8
AUDITOR S REPORT<br />
kend<br />
tland<br />
CHARTERED ACCOUNTANTS<br />
TO<br />
Dave Ryan<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Dave Ryan candidate for the campaign period <strong>of</strong> January 4 2010 to December<br />
31 2010 for the election held on October 25 2010 These financial statements are the responsibility <strong>of</strong><br />
Dave Ryan candidate Our responsibility is to express an opinion on these financial statements based upon<br />
our audit<br />
Except as explained in the we<br />
following paragraph conducted our audit in accordance with Canadian<br />
generally accepted auditing standards Those standards require that we plan and an<br />
perform audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
the amounts and disclosures in the financial statement An<br />
examining on a test basis evidence supporting<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation <strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
wish the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from January 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit<br />
and the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RErNAAU<br />
DRUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 16 2011<br />
Marc A Renaud<br />
307 High Street Whitby<br />
Tel905 666<br />
2720 Fax905<br />
mart@renaudrutland com<br />
Edward Rutland<br />
Ontario LIN 51 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario L1V 4N7<br />
666 1042 Tel905 509 3023 Fax905 509 6895<br />
ed@renaudrutland com
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 04 to 2010 12<br />
I<br />
31<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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name<br />
Ryan<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1028 Rouge Valley Drive<br />
First Name<br />
Dave<br />
I<br />
Middle Initial<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
420 905 2173 509 905<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Mayor<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
1968 mayor@city pickering on ca<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk 61 843 05<br />
was<br />
2 Surplus or deficit from previous election<br />
4237 47<br />
3 Total contributions received from Schedule 1<br />
Is 62 974 13<br />
4 My total campaign expenses that were<br />
subject to the spending limit were from Box C 59 986 25<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 7605 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 67 591 25<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is 2370 35<br />
8 Contributions refunded to candidate or spouse from Box E 00<br />
9 Amount paid to clerk from Box E<br />
I 2370 35<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 04 2010 12 31 Dave Ryan<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 4237 47<br />
Contributions from candidate 00<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions<br />
62 974 13<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 00<br />
Interest income 00<br />
Other provide full details<br />
1 Inventory contributed to campaign 2750 00<br />
2<br />
3<br />
Total Campaign Period Income Is 69 961 60 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 18 889 48<br />
Bank charges 120 22<br />
Brochures 4938 37<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3 2750 00<br />
Nomination filing fee<br />
Office expenses 7475 11<br />
Phone and or Internet 1992 89<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 4000<br />
Signs 7988 22<br />
Other provide full details<br />
1 Database 356 09<br />
2 Rent 4000<br />
3 Postage 475 87<br />
Subtotal 59 986 25<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 1000<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit 00<br />
Expenses related to controverted elections 00<br />
Expenses related to recounts 00<br />
Voting day party appreciation notices 5974 28<br />
Expenses related to candidate s disability provide details<br />
1 00<br />
2<br />
3<br />
Other provide full details<br />
1 Bank Charges 13 71<br />
2 Thank you ad Stamps 559 59<br />
3<br />
Subtotal<br />
C3<br />
7605 00<br />
Total Campaign Period Expenses C2 C3 Is 67 591 25 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 Is 237035<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash 8923 59<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 8923 59<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 6521 84<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities Is 6521 84<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus<br />
or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 2370 35 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 2370 35<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
Is 2370 35 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I Dave Ryan<br />
<strong>Pickering</strong><br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
E2<br />
Declared before clerk or commissioner<br />
in the<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
on<br />
yyyy mm dd 90 L i d3 D 5<br />
Q21 An eUz<br />
Signature <strong>of</strong> Clerk or Commissioner Signatu <strong>of</strong> Candidate<br />
ac It a3 a<br />
Date Filed in the Clerk s Officeyyyy mm<br />
dd DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 10<br />
OF THE COMMISSIONERS TAKING FOR<br />
AFFIDAVITS ACT<br />
it<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
i<br />
Schedule 1<br />
Contributions<br />
i<br />
Part I<br />
Contribution<br />
Contribution from candidate 00<br />
Contribution from spouse 00<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse 62 154 13<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse 820 00<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor 00<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution<br />
62 974 13<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 1113<br />
00 1A<br />
00 1B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
See list at the end <strong>of</strong> the report<br />
Additional information is listed on separate supplementary attachment Total 17 475 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
i<br />
i<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
See list at the end <strong>of</strong> the<br />
report<br />
Additional information is listed on<br />
separate supplementary attachment Total 44 000<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Toshiba Business<br />
191 McNabb Street<br />
Solution Markham ON UR 8H2<br />
Photocopier<br />
Rental 679 13<br />
Additional information is listed on separate supplementary attachment Total 679 13<br />
Total Part II Contributions<br />
62 154 13<br />
9503P 2010101 Page 5 <strong>of</strong> 8
I<br />
Schedule 2Fund Raising Function<br />
Date<br />
Additional schedule for each event or activity<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
Part I Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
Is<br />
213<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
I<br />
I<br />
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate sCampaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
Y Ymm dd<br />
Signs 20 00 110 200<br />
Signs A Frame 50 00 11 550 00<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 2750 00<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
YYYY mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
<strong>Pickering</strong> 2011 03 17<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Rutland Edward 9 l Z<br />
Address<br />
Suite Unit No Street No Street Name<br />
1024 Rouge Valley Drive<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
666 905 6720 ext 902 666<br />
1042 ed@renaudrutland com<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Monetary Contributions from Individuals totalling more than 100<br />
Kazim Qureshi 9 Fielding Crt Ajax<br />
Bhupinder Singh Bajwa 358 Rouge Hill Crt <strong>Pickering</strong><br />
ON L1T 4W5 125 00<br />
ON L1V 6L5 150 00<br />
Dhaman P Kissoon 8 Beamish Drive Toronto ON M913 3133 150 00<br />
Devanand Parsan 535 Lightfoot PL <strong>Pickering</strong><br />
Mary Helen Barnes 499 Summerpark Cres <strong>Pickering</strong><br />
ON L1V 5Z8 200<br />
ON L1V 7A8 200<br />
Maureen Robbins 848 Hillcrest Rd <strong>Pickering</strong> ON L1W 2P7 200<br />
Reginald Harrilal 64 Finchley Cir Markham ON 1311 8S2 200<br />
Preetumsing Anauth 79 Mountland Drive Toronto ON M1G 2132 250 00<br />
Dino Accettone 289 Monarch Ave Ajax<br />
Samlall Persaud 27 Dagwell Cres Ajax<br />
ON L1S OC2 300<br />
ON L1T 3M8 300<br />
Ram Rampersad 21 Royal Rouge Trail Toronto ON M1134T5 350 00<br />
Colleen A Reid 5 Rushbrooke Way Ajax<br />
R Cecil Ramnauth 30 Wickens Cres Ajax<br />
ON L1Z 2C5 400<br />
ON L1T 3M8 400<br />
David Demerino 1101 Kingston Rd Unit 320 <strong>Pickering</strong><br />
Gary Reid 94 Boustead Ave Toronto<br />
ON L1V 1135 500<br />
ON M6R 1Y9 500<br />
Jack Winberg 26 Breen Crescent Willowdale ON M213 1Z7 500<br />
John L MacDonald 359 Cam Fella Blvd Stouffville ON L4A 7G6 500<br />
Steve De Guise 139 Indian Lake Rd RR1 Elgin<br />
Tyler Marche 465 Rougemount Dr <strong>Pickering</strong><br />
Ajay Sirohi 757 Sheppard Ave <strong>Pickering</strong><br />
Arindam Roychowdhury 472 Sheppard Ave <strong>Pickering</strong><br />
C Lynn Harding 713 Glencove Kingston<br />
ON KOG 1EO 500<br />
ON L1W 268 500<br />
ON L1V 1G4 750 00<br />
ON L1V 1E5 750 00<br />
ON K7M 5G1 750 00<br />
Dorothy Wallace Bethany Manor 23 Second St S Unionville ON L3R 2C2 750 00<br />
George Buckles 116 Rochester Avenue Toronto ON M4N 1131 750 00<br />
Greg Clancy 4919 Bellrock Rd Verona ON KOH 2WO 750 00<br />
Guery Goyo 70 Kokanee Court Maple<br />
Helene Walton 78 Brock St Apt 2 Kingston<br />
J Allan Arsenault 17 Charterhouse Drive Whitby<br />
ON L6A 2V8 750 00<br />
ON K7L 1R9 750 00<br />
ON L1R 3R8 750 00<br />
Jasodra Latchmana 90 Promelia Crt Markham ON L3S 3S4 750 00<br />
Martin L Skolnick 1554 Woodbine Rd Kingston<br />
ON K7P 2V8 750 00<br />
Milan Shah 20 Maryvale Cres Richmond Hill ON L4C 6138 750 00<br />
Peter Kostogiannis 1057 Burbrook Road East Glenburnie ON KOH 1SO 750 00<br />
Silvio Degasperis 270 Chrislea Rd Woodbridge<br />
ON 141 8A8 750 00<br />
Vijay Gupta 562 Renforth Dr Etobicoke ON M9C 21 12 750 00<br />
17 475 00
Monetary Contributions from Corporations totalling more than 100<br />
1151001 Ontario Limited OA<br />
2143087 Ontario Limited AHK Group Suite 207<br />
Mr Lube Store 28 1195 Kingston Road <strong>Pickering</strong> ON LIV 1135 150 00<br />
2985 Drew Rd Mississauga ON L4T OA1 150 00<br />
Brennan Paving Construction P0 Box 4080 Markham Markham ON L3R 9R8 200<br />
Fourteen Estates Limited<br />
96 Cawker s Cove Road Port Perry ON L9L 1R6 200<br />
IST D Kishun OA Kishun Enterprises 30 Hunter Drive Ajax<br />
ON L1T 3M9 200<br />
Parsons Brinckerh<strong>of</strong>f 488 Wellington St West Suite 202 Toronto ON M5V 1E3 200<br />
Don Mills Golf Centre Limited P0 Box 4080 Markham Markham ON 13119118 250 00<br />
Global Fabricating Inc 142 Silver Star Boulevard Toronto ON M1V 5P2 250 <strong>Pickering</strong> Square 1986 Inc 1550 Kingston Road Ste 300 <strong>Pickering</strong> ON 1V 1C3 250 00<br />
<strong>Pickering</strong> Square Inc 1550 Kingston Road Ste 300 <strong>Pickering</strong><br />
ON L1V 1C3 250 00<br />
Rougemount Square 1550 Kingston Road Ste 300 <strong>Pickering</strong> ON L1V IC3 250 00<br />
Binns Inc 333 Kingston<br />
Miller Paving<br />
Rd <strong>Pickering</strong> ON L1V IA1 300<br />
Limited P0 Box 4080 Markham Markham ON L3R 9R8 300<br />
Nicou Inc 63 Johnson St Thornhill ON L3T 2N9 300<br />
TIESC NR Corp oa Sante Group Healthcare 105 1315 <strong>Pickering</strong> Parkway <strong>Pickering</strong> ON L1V 7G5 300<br />
Altet Stucco Ltd 7500 Hwy 27 Unit 9 Vaughan ON L4H 012 500<br />
Bayfield Realty Advisors Inc 904 2300 Yonge Street Toronto ON M4P IE4 500<br />
C Valley Paving 40 Bradwick Drive Unit 23 Concord ON L4K 1K9 500<br />
Canadian Tire Associate Store 324 1735 <strong>Pickering</strong> Parkway <strong>Pickering</strong> ON LIV 7C7 500<br />
Sort Can Recycling 1048 Toy Ave <strong>Pickering</strong> ON L1W 3P1 500<br />
Central Glass Mirror Ltd 95 Konrad Cres Unit 2 Markham ON L3R 8T8 500<br />
Chouinard Bros Ro<strong>of</strong>ing 120 Gibson Drive Markham ON L3R 2Z3 500<br />
Designer Deck Inc 101 Planchet Rd Unit 6 Concord ON L4K 2C6 500<br />
Donald Contracting Limited 333 Humberline Drive Rexdale ON M9W 5X3 500<br />
Eco Tec Inc 1145 Squires Beach Road <strong>Pickering</strong> ON L1W 3T9 500<br />
EMCO Masonry Limited 172 Bullock Drive Unit 26 Markham ON L3P 7M9 500<br />
Foremont Drywall Contracting 495 Deerhurst Drive Brampton ON L6T 5K3 500<br />
Ideal Railings Ltd 3076 Lenworth Drive Mississauga ON L4X 2G1 500<br />
Intellimeter Canada Inc 1125 Squires<br />
Leader Plumbing Heating<br />
Beach Road <strong>Pickering</strong> ON L1W 3T9 500<br />
Inc 91 Haist Avenue Units 34 Woodbridge ON L4L SVS 500<br />
Marciano Doors Trim Co Ltd 7060 Pacific Cir Mississauga ON L5T 2A7 500<br />
Monarch Kitchen Bath Centre Limited Unit 6 1020 Brock Road South <strong>Pickering</strong> ON L1W 3H2 500<br />
Newmar Window Manufacturing Inc 7630 Airport<br />
Road Mississauga ON L4T 4G6 500<br />
Paragon Drywall Contractors 59 Romina Drive Suite 201 Concord ON L4K 4Z9 500<br />
Penegal Trim Supply Ltd 261 Regina Rd Woodbridge ON L4L 8M3 500<br />
Reliable Painters Decorators Ltd 5571 Quartermain Cres Mississauga ON LSM5V2 500<br />
Sabourin Kimble Associates Limited 110 Old Kingston Road Ajax<br />
ON LIT 2Z9 500<br />
SAI Restaurants OA Tim Horton s 3463 Kingston Road Scarborough ON M1M 1R4 500<br />
Skentzos 77 Harbour Square Suite 512 Toronto ON M51 2S2 500<br />
St Marys Cement Inc 55 Industrial Street Toronto ON M4G 3W9 500<br />
Star Concrete Pumping<br />
Inc 100 Creditstone Road Concord ON L4K 1P2 500<br />
Sterling Tile and Carpet 505 <strong>City</strong>view Blvd Unit 1 Vaughan ON L4H OL8 500<br />
TAM Electric Ltd 456 Garyray Drive Toronto<br />
ON M9L IP7 500<br />
The Sernas Group 110 Scotia Court 41 Whitby ON LIN 8Y7 500<br />
The Universal Group 1492 Grand Blvd Oakville ON LEH 3E6 500<br />
Velcan Forest Products Inc 1240 Skae Drive Oshawa ON L11 7A1 500<br />
Weston Hardwood Design Centre Inc 250 Vaughan Valley Blvd Woodbridge<br />
ON L4H 3C3 500<br />
1151001 Ontario Limited OA Mr Lube Store 28 1195 Kingston Road <strong>Pickering</strong> ON L1V I65 600<br />
Grant Morris Associates Ltd 397 Sheppard Ave <strong>Pickering</strong> ON L1V 1E6 600<br />
20 VIC Management<br />
Inc One Queen St E Suite 300 Box 88 Toronto ON M5C 2W5 750 00<br />
Alltemp Products Company Limted 827 Brock Rd South <strong>Pickering</strong> ON L1W 312 750 00<br />
Beam Hill Developments Ltd 1815 Ironstone Manor Unit 1 <strong>Pickering</strong> ON L1W 3W9 750 00<br />
Bitondo s Market Limited R No 1 Locus Hill ON LOH 110 750 00<br />
Black McDonald Limited 31 Pullman Court Scarborough ON MIX IE4 750 00<br />
Box Grove Hill Developments Inc 270 Chrislea Rd Woodbridge ON L4L SAS 750 00<br />
Carpet Towne Whitby 419 Dundas Street East Whitby ON LIN 212 750 00<br />
Certworth Services Inc 757 Sheppard Ave <strong>Pickering</strong> ON LIV 1G4 750 00<br />
Derlea Brand Foods Inc 1739 Orangebrook Court <strong>Pickering</strong> ON L1W 3G8 750 00<br />
Harwood Medical Building Corp 555 Kingston Road West Ajax ON L75 6M1 750 00<br />
Invar Building Corporation 220 Duncan Mill Rd Suite 301 Toronto<br />
ON M38 315 750 00<br />
Jodee Truck Leasing Ltd 90 Promelia Court Markham ON L3S 3S4 750 00<br />
John McLellan Contracting 3625 Sideline 26 Claremont ON LIY IA2 750 00<br />
Louisville Homes Limited 11 Colonel Danforth Tr Toronto ON M1C 1P8 750 00<br />
Marchar Holdings Ltd 23 Lesmill Road Suite 111 Toronto ON M3B 3P6 750 00<br />
Massey<br />
Restaurants Ltd 774 Liverpool Road South <strong>Pickering</strong> ON L1W 1R9 750 00<br />
Mattamy Homes Limited 2360 Bristol Circle Oakville ON L6H 61VI5 750 00<br />
Maylar Construction Limited 9488 McCowan Rd Markham ON L3P 313 750 00<br />
Medi Group Incorporated 56 Brockport Drive Toronto ON M9W 5N1 750 00<br />
Morgan s Port Restaurant 1289 Wharf Street <strong>Pickering</strong> ON L1W 1A2 750 00<br />
Orion Realty Corporation Realtor 3550 victoria Park Ave Suite 500 Toronto ON M2H 2N5 750 00<br />
<strong>Pickering</strong> Honda 575 Kingston Rd <strong>Pickering</strong> ON LIV 3N7 750 00<br />
<strong>Pickering</strong> Toyota Limited 575 Kingston Rd <strong>Pickering</strong> ON LIV 3N7 750 00<br />
Picore Holdings Limited 80 Queen Street Kingston ON K7K 6W7 750 00<br />
Purdue Frederick 575 Garnite Court <strong>Pickering</strong> ON L1W 3W8 750 00<br />
Runnymede Development Corporation Ltd 1051 Tapscott Road Toronto ON MIX IAI 750 00<br />
Sr R Bay Ridges TWO LTD 150 Ferrand Drive Suite 801 Toronto ON M3C 3E5 750 00<br />
The Bench Press LTD OA Creative Outdoor Avertsising 2402 Stouffville Rd PO Box 245 Gormley ON LOH 1GO 750 00<br />
Villarboit Development Corporation Unit 5 151 Spinnaker Way Concord ON L4K 4C3 750 00<br />
Walker Head Barristers and Solicitors 1340 Kingston Rd Unit 5 <strong>Pickering</strong> ON LIV 31V9 750 00<br />
White Sun Developments Limited 4576 Yonge St Suite 500 Toronto ON M2N 6N4 750 00<br />
44 000
Shields Debbie<br />
Subject<br />
Importance<br />
FW Confirmation <strong>of</strong> contribution<br />
High<br />
From Sylvain Trepaniermailto DR CFO@mail com<br />
Sent April 5 20119 12 PM<br />
To Shields Debbie<br />
Cc Mayor Web Email<br />
Subject<br />
Importance High<br />
Confirmation <strong>of</strong> contribution<br />
Debbie<br />
as treasurer for Dave Ryan s election campaign I confirm the following<br />
Dave Ryan s Campaign concluded on December 31 2010 and therefore the extension we had requested is<br />
no longer required<br />
All contributions declared on Form 4 have been received and deposited in the campaign account<br />
prior to December 31 2010<br />
No contribution was received after December 31 2010<br />
All accounts payable as at December 31 2010 have been paid since then so at the time <strong>of</strong> filing<br />
the report there was no outstanding payable<br />
Also at the timing <strong>of</strong> filing the report the bank account had been closed with the final<br />
disbursement <strong>of</strong> the surplus paid to the <strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Hope everything is in order and this is what you were looking for In the event you require further<br />
information or clarifications please do not hesitate to contact me<br />
Regards<br />
Sylvain Trepanier<br />
Treasurer<br />
Dave Ryan Campaign 2010<br />
Work 440 416 8300 ext 42329<br />
1
AUDITOR S REPORT<br />
NoC c o<br />
IV<br />
ECAe nSo<br />
Nxiok<br />
C<br />
S inn 1 L<br />
CHARTERED ACCOUNTANTS<br />
Sc VYX C S Prt mar<br />
TO<br />
Dave Ryan<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Dave Ryan candidate for the campaign period <strong>of</strong> January 4 2010 to December<br />
31 2010 for the election held on October 25 2010 These financial statements are the responsibility <strong>of</strong><br />
Dave Ryan candidate Our responsibility is to express an opinion on these financial statements based upon<br />
our audit<br />
Except as explained in the following paragraph<br />
generally accepted auditing standards Those standards require that we plan and perform<br />
we conducted our audit in accordance with Canadian<br />
an audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
examining on a test basis evidence supporting<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
the amounts and disclosures in the financial statement An<br />
candidate as well as evaluating the overall presentation <strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from January 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit<br />
and the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 16 2011<br />
Marc A Renaud<br />
Edward Rutland<br />
307 High Street Whitby Ontario LIN 5H7 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario LtV 4N7<br />
Tel 666 905 2720 Fax 905 1042 666<br />
Tel 509 905 3023 Fax905 509 6895<br />
marc<br />
@renaudrutland com<br />
ed@renaudrutland com
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong> 10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 04 to 2010 12 31<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Ryan<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1028 Rouge Valley Drive<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1V 4N7<br />
Dave<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
420 905 2173 509 905<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Mayor<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
1968 mayor@city pickering on ca<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 61 843 05<br />
2 Surplus or deficit from previous election<br />
4237 47<br />
3 Total contributions received from Schedule 1 62 974 13<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
LS 59 986 25<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 7605 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 67 591 25<br />
7 Election campaign surplus deficit from current election from Box E 2370 35<br />
8 Contributions refunded to candidate or<br />
spouse from Box E 00<br />
9 Amount paid to clerk from Box E 2370 35<br />
9503P 2010101<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 04 2010 12 31 Dave Ryan<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 4237 47<br />
Contributions from candidate 00<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions<br />
62 974 13<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 00<br />
Interest income 00<br />
Other provide full details<br />
1 Inventory contributed to campaign 2750 00<br />
2<br />
3<br />
Total Campaign Period Income<br />
Is 69 961 60 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 18 889 48<br />
Bank charges 120 22<br />
Brochures 4938 37<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3 2750 00<br />
Nomination filing fee<br />
Office expenses 7475 11<br />
Phone and or Internet 1992 89<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 4000<br />
Signs 7988 22<br />
Other provide full details<br />
1 Database 356 09<br />
2 Rent 4000<br />
3 Postage 475 87<br />
Subtotal 59 986 25<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 1000<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part Iv<br />
Expenses related to compliance audit 00<br />
Expenses related to controverted elections 00<br />
Expenses related to recounts 00<br />
Voting day party appreciation notices 5974 28<br />
Expenses<br />
related to candidate s disability provide details<br />
1 00<br />
2<br />
3<br />
Other provide full details<br />
1 Bank Charges<br />
71 13<br />
2 Thank you ad Stamps 559 59<br />
3<br />
Subtotal C3<br />
is 7605 00<br />
Total Campaign Period Expenses C2 C3 67 591 25 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 2370 35<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash 8923 59<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets 8923 59<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 6521 84<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Is 6521 84<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 2370 35 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
E2<br />
Surplus or deficit for the campaign period E1 E2 2370 35<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
2370 35 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
<strong>Pickering</strong><br />
Box F Declaration<br />
I Dave Ryan<br />
a candidate in the municipality <strong>of</strong><br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
on<br />
yyyy mm dd o2G i 3<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signatur<br />
a <strong>of</strong> Candidate<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
ELraS<br />
FOFFFICIO CITY CLERK<br />
KERING<br />
COMMISSIONER<br />
TO SECTION 112<br />
MISSIONERS FOR<br />
DAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 00<br />
Contribution from spouse 00<br />
Total from each single contributor totalling<br />
more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse 62 154 13<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
820 00<br />
Less Contribution returned or payable to the contributor 00<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 62 974 13<br />
00 1A<br />
Total contribution from anonymous sources 00 113<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
Part 11 List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
See list at the end <strong>of</strong> the report<br />
Additional information is listed on<br />
separate supplementary attachment Total 17 475 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
i<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying<br />
on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
See list at the end <strong>of</strong> the<br />
report<br />
Additional information is listed on separate supplementary attachment Total 44 000<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Toshiba Business<br />
191 McNabb Street<br />
Solution Markham ON L3R 8H2<br />
Photocopier<br />
Rental 679 13<br />
Additional information is listed on separate supplementary attachment Total 679 13<br />
Total Part II Contributions<br />
62 154 13<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Date<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
2A<br />
Number <strong>of</strong> tickets sold 213<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2B include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part 111 Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
I<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy m mdd<br />
Signs I 20 00 110 200<br />
Signs A Frame 50 00 11 550 00<br />
r<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 2750 00<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy m mdd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010101 Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
<strong>Pickering</strong> 2011 03 17<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Rutland Edward L<br />
Address<br />
Suite Unit No Street No Street Name<br />
1024 Rouge Valley Drive<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
666 905 6720 ext 902 666<br />
1042 ed@renaudrutland com<br />
9503P 2010101 Page 8 <strong>of</strong> 8
Monetary Contributions from Individuals totalling more than 100<br />
Kazim Qureshi 9 Fielding Crt Ajax<br />
Bhupinder Singh Bajwa 358 Rouge Hill Crt <strong>Pickering</strong><br />
ON LIT 4W5 125 00<br />
ON L1V 615 150 00<br />
Dhaman P Kissoon 8 Beamish Drive Toronto ON M96 3P3 150 00<br />
Devanand Parsan 535 Lightfoot PL <strong>Pickering</strong><br />
Mary Helen Barnes 499 Summerpark Cres <strong>Pickering</strong><br />
Maureen Robbins 848 Hillcrest Rd <strong>Pickering</strong><br />
ON L1V 5Z8 200<br />
ON L1V 7A8 200<br />
ON L1W 2P7 200<br />
Reginald Harrilal 64 Finchley Cir Markham ON L3R 8S2 200<br />
Preetumsing Anauth 79 Mountland Drive Toronto ON M1G 2132 250 00<br />
Dino Accettone 289 Monarch Ave Ajax<br />
Samlall Persaud 27 Dagwell Cres Ajax<br />
Ram Rampersad 21 Royal Rouge Trail Toronto<br />
Colleen A Reid 5 Rushbrooke Way Ajax<br />
R Cecil Ramnauth 30 Wickens Cres Ajax<br />
ON L1S OC2 300<br />
ON LIT 31VI8 300<br />
ON M1B 4T5 350 00<br />
ON LIZ 2C5 400<br />
ON LIT 31V18 400<br />
David Demerino 1101 Kingston Rd Unit 320 <strong>Pickering</strong> ON L1V 1135 500<br />
Gary Reid 94 Boustead Ave Toronto<br />
ON M611 1Y9 500<br />
Jack Winberg 26 Breen Crescent Willowdale ON M213 1Z7 500<br />
John L MacDonald 359 Cam Fella Blvd Stouffville ON L4A 7G6 500<br />
Steve De Guise 139 Indian Lake Rd RR1 Elgin ON KOG 1EO 500<br />
Tyler Marche 465 Rougemount Dr <strong>Pickering</strong><br />
Ajay Sirohi 757 Sheppard Ave <strong>Pickering</strong><br />
Arindam Roychowdhury 472 Sheppard Ave <strong>Pickering</strong><br />
C Lynn Harding 713 Glencove Kingston<br />
ON L1W 2138 500<br />
ON L1V 1G4 750 00<br />
ON L1V 1E5 750 00<br />
ON K7M 5G1 750 00<br />
Dorothy Wallace Bethany Manor 23 Second St S Unionville ON L3R 2C2 750 00<br />
George Buckles 116 Rochester Avenue Toronto ON M4N 1P1 750 00<br />
Greg Clancy 4919 Bellrock Rd Verona ON KOH 2WO 750 00<br />
Guery Goyo 70 Kokanee Court Maple<br />
Helene Walton 78 Brock St Apt 2 Kingston<br />
J Allan Arsenault 17 Charterhouse Drive Whitby<br />
ON L6A 2V8 750 00<br />
ON K7L 1R9 750 00<br />
ON 111 3R8 750 00<br />
Jasodra Latchmana 90 Promelia Crt Markham ON L3S 3S4 750 00<br />
Martin L Skolnick 1554 Woodbine Rd Kingston<br />
ON K7P 2V8 750 00<br />
Milan Shah 20 Maryvale Cres Richmond Hill ON L4C 6138 750 00<br />
Peter Kostogiannis 1057 Burbrook Road East Glenburnie<br />
ON KOH ISO 750 00<br />
Silvio Degasperis 270 Chrislea Rd Woodbridge ON 141 8A8 750 00<br />
Vijay Gupta 562 Renforth Dr Etobicoke<br />
ON M9C 2N2 750 00<br />
17 475 00
Monetary Contributions from Corporations totalling more than 100<br />
1151001 Ontario Limited OA Mr Lube Store 28 1195 Kingston<br />
Road <strong>Pickering</strong> ON L1V 185 150 00<br />
2143087 Ontario Limited AHK Group Suite 207 2985 Drew Rd Mississauga<br />
ON L4T OA1 150 00<br />
Brennan Paving Construction P0 Box 4080 Markham Markham ON 3R 9R8 200<br />
Fourteen Estates Limited<br />
96 Cawker s Cove Road Port Perry ON 191 1R6 200<br />
IST 0 Kishun 0A Kishun Enterprises 30 Hunter Drive Ajax ON LIT 19 31<br />
200<br />
Parsons Brinckerh<strong>of</strong>f 488 Wellington<br />
St West Suite 202 Toronto ON M5V IE3 200<br />
Don Mills Golf Centre Limited P0 Box 4080 Markham Markham ON L3R 9R8 250 00<br />
Global Fabricating<br />
142 Silver Star Boulevard Toronto ON M1V SP2 250 Inc<br />
<strong>Pickering</strong> Square 1986 Inc 1550 Kingston Road Ste 300 <strong>Pickering</strong> ON L1V 1C3 S 250 00<br />
<strong>Pickering</strong> Square Inc 1550 Kingston Read Ste 300 <strong>Pickering</strong><br />
Rougemount Square 1550 Kingston Road Ste 300 <strong>Pickering</strong><br />
Binns Inc 333 Kingston<br />
ON L1V 1C3 250 00<br />
ON L1V 1C3 250 00<br />
Rd <strong>Pickering</strong> ON L1V JAI 300<br />
Miller Paving Limited P0 Box 4080 Markham Markham ON L3R 9R8 300<br />
Nicou Inc 63 Johnson St Thornhill ON L3T 2N9 300<br />
TIESC NR Corp oa Same Group Health Care 105 1315 <strong>Pickering</strong> Parkway <strong>Pickering</strong> ON L1V 7G5 300<br />
Altet Stucco Ltd 7500 Hwy 27 Unit 9 Vaughan<br />
ON L4H 012 500<br />
Bayfield Realty Advisors Inc 904 2300 Yonge Street Toronto ON M4P 1E4 500<br />
C 40 Valley Paving Bradwick Drive Unit 23 Concord ON L4K 1K9 500<br />
Canadian Tire Associate Store 324 1735 <strong>Pickering</strong> Parkway <strong>Pickering</strong> ON L1V 7C7 500<br />
Can Sort Recycling 1048 Toy Ave <strong>Pickering</strong> ON L1W 3P1 500<br />
Central Glass Mirror Ltd 95 Konrad Cres Unit 2 Markham ON L3R 8T8 500<br />
Chouinard Bros Ro<strong>of</strong>ing 120 Gibson Drive Markham ON L3R 2Z3 500<br />
Designer<br />
Deck Inc 101 Planchet Rd Unit 6 Concord ON L4K 2C6 500<br />
Donald Contracting<br />
Limited 333 Humberline Drive Rexdale ON M9W SX3 500<br />
Eco Tec Inc 1145 Squires Beach Road <strong>Pickering</strong> ON L1W 3T9 500<br />
EMCO Masonry Limited 172 Bullock Drive Unit 26 Markham ON L3P 7M9 500<br />
Foremont Drywall Contracting 495 Deerhurst Drive Brampton ON 6T 5K3 500<br />
Ideal Railings Ltd 3076 Lenworth Drive Mississauga ON L4X 2G1 500<br />
Intellimeter Canada Inc 1125 Squires Beach Road <strong>Pickering</strong> ON L1W 3T9 500<br />
Leader Plumbing Heating Inc 91 Haist Avenue Units 34 Woodbridge<br />
ON L4L 5V5 500<br />
Marciano Doors Trim Co Ltd 7060 Pacific Cir Mississauga ON L5T 2A7 500<br />
Monarch Kitchen Bath Centre Limited Unit 6 1020 Brock Road South <strong>Pickering</strong><br />
ON L1W 3H2 500<br />
Newmar Window Manufacturing Inc 7630 Airport Road Mississauga ON L4T 4G6 500<br />
Paragon Drywall Contractors 59 Romina Drive Suite 201 Concord ON L4K 4Z9 500<br />
Penegal Trim Supply Ltd 261 Regina<br />
Rd Woodbridge ON L4L 8M3 500<br />
Reliable Painters Decorators Ltd 5571 Quartermain Cres Mississauga ON L5M5V2 500<br />
Sabourin Kimble Associates Limited 110 Old Kingston<br />
Road Ajax ON LIT 2Z9 500<br />
SAI Restaurants 0A Tim Horton s 3463 Kingston Road Scarborough ON M1M 1R4 500<br />
Skentzos 77 Harbour Square Suite 512 Toronto ON M5J 2S2 500<br />
St Marys Cement Inc 55 Industrial Street Toronto ON M4G 3W9 500<br />
Star Concrete Pumping<br />
Inc 100 Creditstone Road Concord ON L4K 1P2 500<br />
Sterling Tile and Carpet SOS <strong>City</strong>view Blvd Unit 1 Vaughan ON L4H OL8 500<br />
TAM Electric Ltd 456 Garyray Drive Toronto ON M9L 1P7 500<br />
The Sernas Group 110 Scotia Court 41 Whitby ON LIN 8Y7 500<br />
The Universal Group 1492 Grand Blvd Oakville ON LEH 3E6 500<br />
Velcan Forest Products Inc 1240 Skae Drive Oshawa ON L1J 7A1 500<br />
Weston Hardwood Design Centre Inc 250 Vaughan Valley Blvd Woodbridge<br />
ON L4H 3C3 500<br />
1151001 Ontario Limited OA Mr Lube Store 428 1195 Kingston Road <strong>Pickering</strong> ON L1V 1135 600<br />
Grant Morris Associates Ltd 397 Sheppard Ave <strong>Pickering</strong> ON L1V 1E6 600<br />
20 VIC Management<br />
Inc One Queen St E Suite 300 Box 88 Toronto ON MSC 2W5 750 00<br />
Alltemp Products Company Limted 827 Brock Rd South <strong>Pickering</strong> ON L1W 3J2 750 00<br />
Beam Hill Developments Ltd 1815 Ironstone Manor Unit 1 <strong>Pickering</strong> ON L1W 3W9 750 00<br />
Bitondo s Market Limited R No 1 Locus Hill ON LOH 110 750 00<br />
Black McDonald Limited 31 Pullman Court Scarborough ON MIX 1E4 750 00<br />
Box Grove Hill Developments Inc 270 Chrislea Rd Woodbridge ON L4L 8A8 750 00<br />
Carpet Towne Whitby 419 Dundas Street East Whitby ON LIN 2J2 750 00<br />
Certworth Services Inc 757 Sheppard Ave <strong>Pickering</strong><br />
ON L1V 1G4 750 00<br />
Derlea Brand Foods Inc 1739 Orangebrook Court <strong>Pickering</strong> ON L1W 3G8 750 00<br />
Harwood Medical Building Corp 555 Kingston Road West Ajax ON L1S 6M1 750 00<br />
Invar Building Corporation 220 Duncan Mill Rd Suite 301 Toronto ON M38 3J5 750 00<br />
Jodee Truck Leasing Ltd 90 Promelia Court Markham ON L35 3S4 750 00<br />
John McLellan Contracting 3625 Sideline 26 Claremont ON L1Y IA2 750 00<br />
Louisville Homes Limited 11 Colonel Danforth Tr Toronto ON M1C IP8 750 00<br />
Marchar Holdings<br />
Massey<br />
Restaurants Ltd<br />
Mattamy<br />
Ltd 23 Lesmill Road Suite 111 Toronto ON M3B 3P6 750 00<br />
774 Liverpool Road South <strong>Pickering</strong> ON L1W 1R9 750 00<br />
Homes Limited 2360 Bristol Circle Oakville ON LEH EMS 750 00<br />
Maylar Construction Limited 9488 McCowan Rd Markham ON L3P 3J3 750 00<br />
Medi Group incorporated 56 Brockport Drive Toronto ON M9W 5N1 750 00<br />
Morgan s Port Restaurant 1289 Wharf Street <strong>Pickering</strong> ON LSW IA2 750 00<br />
Orion Realty Corporation<br />
Realtor 3550 victoria Park Ave Suite 500 Toronto ON M2H 2N5 750 00<br />
<strong>Pickering</strong> Honda 575 Kingston Rd <strong>Pickering</strong><br />
ON L1V 3N7 750 00<br />
<strong>Pickering</strong> Toyota Limited 575 Kingston Rd <strong>Pickering</strong> ON L1V 3N7 750 00<br />
Picore Holdings Limited 80 Queen Street Kingston<br />
ON K7K 6W7 750 00<br />
Purdue Frederick 575 Garnite Court <strong>Pickering</strong> ON L1W 3W8 750 00<br />
Runnymede Development Corporation Ltd 1051 Tapscott Road Toronto ON MIX IAI 750 00<br />
Sr R Bay Ridges TWO<br />
LTD 150 Ferrand Drive Suite 801 Toronto ON M3C 3ES 750 00<br />
The Bench Press LTD 0A Creative Outdoor Avertsising 2402 Stouffville Rd PO Box 245 Gormley<br />
ON LOH 1GO 750 00<br />
Villarboit Development Corporation Unit S 151 Spinnaker Way Concord ON L4K 4C3 750 00<br />
Walker Head Barristers and Solicitors 1340 Kingston Rd Unit 5 <strong>Pickering</strong> ON L1V 3M9 750 00<br />
White Sun Developments Limited 4576 Yonge St Suite 500 Toronto ON M2N 6N4 750 00<br />
44 000
te<br />
r Ontario and Housing<br />
Ministry <strong>of</strong> Municipal Affairs<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 821<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> a by election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Candidate Registrant<br />
Last Name First Na a Mid ial<br />
Mailing Address<br />
Suite Unit No<br />
Street No<br />
e3<br />
StKet Name<br />
7 Gti<br />
Province<br />
<strong>City</strong> Town Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
cBusiness<br />
Home<br />
l eS 490 Y4000 05 6 Lti 4S QGi<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the<br />
question for which the registrant incurred expenses<br />
Name <strong>of</strong> Municipality<br />
Declaration<br />
r<br />
ee4eI<br />
Ward name or no if any<br />
I yty<br />
the<br />
Jy candidate registrant mentioned above hereby give notice<br />
and declare to the clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
a<br />
Declared before me<br />
at the<br />
C N<br />
<strong>of</strong><br />
in the<br />
Pkr<br />
Ru a<br />
<strong>of</strong><br />
Gvn<br />
this<br />
6 day <strong>of</strong> e ce p r r 120 1<br />
Signature <strong>of</strong> Clerk Signature idate Registrant<br />
X0 1 O l 1210 joioli 4<br />
Date yyyy mm dd<br />
Date yyyy mm dd<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en frangais
era<br />
l yid<br />
AUDITOR S REPORT<br />
CHARTERED ACCOUNTANTS<br />
TO<br />
Bonnie Littley<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Bonnie Littley candidate for the campaign period <strong>of</strong> January 3 2010 to<br />
December 31 2010 for the election held on October 25 2010 These financial statements are the<br />
responsibility <strong>of</strong> Bonnie Littley candidate Our responsibility is to express an opinion on these financial<br />
statements based upon our audit<br />
Except as explained in the following paragraph<br />
generally accepted auditing standards Those standards require that we<br />
plan and perform<br />
we conducted our audit in accordance with Canadian<br />
an audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
examining on a test basis evidence supporting the amounts and disclosures in the financial statement An<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as<br />
evaluating the overall presentation <strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical<br />
auditing procedures to determine through<br />
that the accounting records and include all donations <strong>of</strong> goods and services<br />
receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to<br />
the financial ensuring the<br />
statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our<br />
opinion except for the effect <strong>of</strong> any adjustments if any which we<br />
might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the<br />
<strong>of</strong> the candidate s election financial position<br />
campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from January 3 2010 to December 31 2010 and the determination<br />
and the disposition <strong>of</strong> <strong>of</strong> surplus deficit<br />
surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not<br />
require us to report nor was it practical for us to<br />
determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario<br />
January 6 2011<br />
klarc A Renaud<br />
307<br />
Edward Rutland<br />
High Street Whitby Ontario LIN 51 17 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario Ll V 4N7<br />
Tel 905 2720 660 Fax 666 905 1042<br />
mare 3renaudtu0and com<br />
Tel905 509<br />
3023 Fax 905 509 6995<br />
ed @renaudrutland com
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong> 10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 1<br />
2010 I 01<br />
I<br />
04<br />
I<br />
to<br />
12010 I<br />
12<br />
I<br />
31<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 <strong>of</strong> Candidate artd Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Littley<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
583<br />
Daylight Court<br />
Bonnie<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1V 6B2<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
420 905 0667<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Regional Councillor Ward 1<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was<br />
2 Surplus or deficit from previous election<br />
s 23 882 00<br />
00<br />
3 Total contributions received from Schedule 1<br />
16 490 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
I 15 317 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 173 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
16 490 00<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is 00<br />
8 Contributions refunded to candidate or spouse from Box E<br />
Is 00<br />
9 Amount paid to clerk from Box E<br />
00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible an frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 04 2010 12 31 Bonnie Littley<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate<br />
5190 00<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
8050 00<br />
1<br />
Campaign materials from previous campaign 3250 00<br />
2<br />
3<br />
Total Campaign Period Income<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Is 16 490 00 C1<br />
Expenses Subject to Spending Limit<br />
Advertising 1502 00<br />
Bank charges 90 00<br />
Brochures<br />
Interest on loan<br />
8201 00<br />
Inventory contributed to candidate campaign Schedule 3 3250 00<br />
Meetings hosted<br />
276 00<br />
Nomination filing fee<br />
Office expenses 70 00<br />
Phone and or Internet<br />
Salaries and benefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
383 00<br />
1 polling data base 1545 00<br />
2<br />
3<br />
Subtotal<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong> fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
15 317 00 C2<br />
763 00<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
410 00<br />
2<br />
3<br />
Other provide full details<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2 C3<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1<br />
9503P 2010101<br />
C4<br />
173 00 C3<br />
16 490 00 C4<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash<br />
Accounts receivable<br />
4326 00<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
4326 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 2474 00<br />
Borrowings overdraft<br />
Other provide full details<br />
1 Repayment <strong>of</strong> candidate advances 1852 00<br />
2<br />
3<br />
Total Liabilities<br />
Is 4326 00<br />
Box E Statement <strong>of</strong> Determination<strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
Part 11 Disposition <strong>of</strong> Surplus<br />
E2<br />
Is<br />
E1<br />
E2<br />
E3<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
r<br />
Box F Declaration<br />
I Bombe Littley<br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
Cil j<br />
on<br />
yyyy mm dd a11 03 O1<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
ao t<br />
116 3 y3<br />
na ure <strong>of</strong> Cand<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
SA DIANNE HARKER<br />
Commissioner etcRegionalMun icipal dv<br />
f Durham for The Corporation <strong>of</strong> the<br />
ity <strong>of</strong> <strong>Pickering</strong><br />
xplres January 28 2012<br />
9503P 2010101<br />
Page 3 <strong>of</strong> 8
Schedule 1 Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 5190 00<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse Is 700<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse Is 350 00<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 13 240 00<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Lorne Almack 4745 Brock Road Claremont L1 V 6132 750 00<br />
David Currie 5160 Westney Road Claremont L1V lAl 500<br />
William Wilder 5535 Sideline 12 Claremont L IY I A 1 500<br />
John McCutcheon 16 Dancliffe Drive North York M4N 2E6 500<br />
Michale Tucker 2580 Concession Road 7 Uxbridge<br />
Brian Buckles 2300 Concession Road 7 Uxbridge<br />
L9P IR4 500<br />
L9P 1R4 500<br />
John Shobridge 645 Breezy Drive <strong>Pickering</strong> 300<br />
Sandra Rider 494 Whitevale Road Whitevale LOH IMO 500<br />
Wendy Dobson 2901 Concession Road 7 Uxbridge<br />
L9P IR4 500<br />
Terry Nuspl 140 Woodview Drive <strong>Pickering</strong> 750 00<br />
Rosemary Speirs 1815 Altona Road <strong>Pickering</strong><br />
LIV 1M6 750 00<br />
Eric Wolfinan 1240 Ilona Park <strong>Pickering</strong> 250 00<br />
Isabel Thompson Whitevale Ontario 150 00<br />
Additional information is listed on separate supplementary attachment Total 6450 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or<br />
Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Creative Outdoor<br />
Advertising<br />
2402 Stoufville Road Gormley 750 00<br />
J VanNostrad Planning<br />
Ltd<br />
14 Summerhill Gardens Toronto 500<br />
Additional information is listed on separate supplementary attachment Total<br />
1250 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
700<br />
Page 5 <strong>of</strong> 8
Schedule 2fund Raising Function<br />
Additional schedule for each event or<br />
activity heldis are listed on separate supplementary attachment s<br />
Description <strong>of</strong> event or activity<br />
Date<br />
YYYY MM DD<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
Part I Ticket Revenue<br />
2A<br />
2B<br />
Lines 2A x 213 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full details eg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full details eg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to<br />
Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory o Campaign Goods and Materials from Previous Carpaigrsj<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyylmm dd<br />
Lawn signs Odee Display 650 400 2600<br />
Arterial signs Odee Display 650 100 650 00<br />
Total Value <strong>of</strong> Inventory from Previous Campaign Used in Candidate s Campaign<br />
3250 00<br />
Schedule 4<br />
Inventory <strong>of</strong> Campaign Goods andMaterials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditbris<strong>Report</strong><br />
MunicipalElections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The<br />
must be done in accordance with<br />
report<br />
generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyylmr<br />
7 10 06<br />
<strong>Pickering</strong> 2011<br />
Contact Person<br />
Last Name<br />
Rutland<br />
Address<br />
Suite Unit No Street No Street Name<br />
307<br />
High Street<br />
First Name<br />
Edward 116<br />
Licence No<br />
<strong>City</strong> Town<br />
Province<br />
Postal Code<br />
Whitby ON L1N 5H7<br />
Telephone No incl area code Fax No Email Address<br />
905 2720 666 ext 905 666 1042<br />
ED@RENAUDRUTLAND COM<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
AUDITOR S REPORT<br />
kted<br />
tlcand<br />
CHARTERED ACCOUNTANTS<br />
TO<br />
JenniferOConnell<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Supplementary Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong><br />
Surplus and Assets and Liabilities <strong>of</strong> Jennifer OConnell candidate for the campaign period <strong>of</strong> January 4<br />
2010 to June 30 2011 for the election held on October 25 2010 These financial statements are the<br />
responsibility <strong>of</strong> JenniferOConnell candidate Our responsibility is to express an opinion<br />
financial statements based upon<br />
our audit<br />
Except as explained in the following paragraph<br />
generally accepted auditing standards Those standards require that we plan and perform<br />
on these<br />
we conducted our audit in accordance with Canadian<br />
an audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
examining on a test basis evidence supporting the amounts and disclosures in the financial statement An<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation<br />
<strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at June 30 2011 and the income and expenses for the campaign<br />
period from January 4 2010 to June 30 201 land the determination <strong>of</strong> surplus deficit and the disposition<br />
<strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
retained in accordance with the<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS<br />
LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario August 12 2011<br />
larr Renaud Ld ard Rolland<br />
Iligh SheetNhi hc Ontario LIN 5117<br />
024 R1R 1C Valley Drive <strong>Pickering</strong> Ontario LIV 4N7<br />
I 004 6670 104 666 905 Fax<br />
Tel 905 509 023 Fax 9115 509 6<br />
iin 1nuJru IinJm<br />
CI WIMMlruilandLruin
s <strong>Report</strong><br />
r Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
yyyy MM DD yyyy mm DD<br />
For the campaign period from day candidate filed nomination 2010 1 4 to 2011 6 30<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<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
45th day after voting day in a by election<br />
Last Name First Name Middle Initial<br />
OCONNELL JENNIFER C<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1596 SEGUIN SQUARE<br />
<strong>City</strong> Town Province Postal Code<br />
PICKERING ON LI V 6T4<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 420 2282 905 0802 420 jenniferoconnell@sympatico ca<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
REGIONAL COUNCILLOR<br />
Name <strong>of</strong> Municipality<br />
CITY OF PICKERING<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
ONE<br />
1 My spending limit as issued by clerk<br />
was 23882<br />
2 Surplus or deficit from previous election 1663<br />
3 Total contributions received from Schedule 1<br />
Is<br />
25071<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 22078<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 1624<br />
6 Total <strong>of</strong> all campaign expenses from Box C 23702<br />
7 Election campaign surplus deficit from current election from Box E 1369<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E 0<br />
9503P 2010101<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 1 4 2011 6 30 JENNIFEROCONNELL<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 0<br />
Contributions from spouse <strong>of</strong> candidate 0<br />
All other contributions 24539<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part lll<br />
Interest income 0<br />
Other provide full details<br />
1<br />
Inventory transferred 532<br />
2 0<br />
3 0<br />
Total Campaign Period Income 25 071 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 338<br />
Bank charges 149<br />
Brochures 7600<br />
Interest on loan 0<br />
Inventory<br />
contributed to candidate s campaign Schedule 3 532<br />
Meetings hosted 0<br />
Nomination filing fee<br />
Office expenses 577<br />
Phone and or Internet 659<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 2306<br />
Signs 5710<br />
Other provide full details<br />
1 PROMO TIONAL 4207<br />
2<br />
3 00<br />
0<br />
Subtotal 22 078 00 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 1231<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV 0<br />
Expenses related to compliance audit 0<br />
Expenses related to controverted elections 0<br />
Expenses related to recounts 00<br />
Voting day party appreciation notices 393<br />
Expenses<br />
related to candidate s disability provide details<br />
1 00<br />
2 00<br />
3 00<br />
Other provide full details<br />
1 00<br />
2 00<br />
3 00<br />
Subtotal 1624 00 C3<br />
Total Campaign Period Expenses C2 C3 Is 23 702 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 1369 00<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at June 30 2011<br />
Assets<br />
Cash 1369<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
0<br />
2 00<br />
3<br />
00<br />
Total Assets<br />
1369 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
0<br />
Borrowings overdraft 0<br />
Other provide full details<br />
1<br />
00<br />
2<br />
00<br />
3<br />
00<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 1369 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
1663 E2<br />
Surplus or deficit for the campaign period E1 E2<br />
294<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
294 E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible<br />
for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I JenniferOConnell<br />
a candidate in the municipality <strong>of</strong><br />
<strong>Pickering</strong><br />
hereby declare that to the best <strong>of</strong> 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 />
C k w c CrKGr<br />
on YYYY mm dd 20 L 1<br />
OR Ifs<br />
Signature <strong>of</strong> Clerk or Commissioner DEBBIE M SHI CIT<br />
CITY OF PI<br />
ERINGY CLERK<br />
p4p O I EX FICIO COMMISSIONER<br />
Date Filed in the Clerk s Office yyyy mm dd PURSUANT TO SECTION 12<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
ature <strong>of</strong> Candidate<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
0<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse Is 24499<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse Is<br />
40<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor 0<br />
Contribution paid or payable to the clerk 0 1A<br />
Total Amount <strong>of</strong> Contribution 24 539 00<br />
Total contribution from anonymous sources 0 113<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
first schedule 5250<br />
second schedule supplementary 3250<br />
Additional information is listed on separate supplementary attachment Total 11500<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor 0<br />
0<br />
24499<br />
Contribution paid or payable to the clerk 0 1A<br />
Total Amount <strong>of</strong> Contribution 24 539 00<br />
Total contribution from anonymous sources 0 113<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
40<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
first schedule 8250<br />
second schedule amended 3250<br />
Additional information is listed on separate supplementary attachment Total 11500<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment Total 10 850 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment Total 2149 23<br />
Total Part II Contributions 24499<br />
9503P 2010101 Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 26 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Is<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010101 Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Bag Sign<br />
Frames 2006 09 27 Arrow Plastics 125 50 50 62<br />
Bag Signs 27 2006 09 Arrow Plastics 195 50 97 50<br />
Large Signs 2006 10 31 Jason Logrippo 50 17 20 350 00<br />
Web Domain 2006 07 26 Netfirms com 22 13 1 22 13<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 532 13<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
ymm dd<br />
Bag Signs<br />
with Frames 2010 09<br />
Avenue Road 495 314 1554 30<br />
Advertising<br />
Coroplast Signs 2010 09 15 Print Fast 18 12 90 1096 20<br />
Magnetic Car Sign 2010 09 15 Print Fast 00 50<br />
4 200<br />
Web Domain 2010 02 13 Netfirms com 59 70 1 59 70<br />
Rebar 2010<br />
The Buckley Group 300 90 270 00<br />
Data 2010 07 27 7514433 Canada Corp 05 10 000 500<br />
Rebar 2010 09 15 The Buckley Group 400 105 420 00<br />
Magnets 13 2010 09 Clarington Promotions 029 1000 290 00<br />
Campaign<br />
Campaign<br />
Jackets 2010 04 14 Giant Tiger<br />
DoreenOConnell<br />
Shirts 2010 07<br />
Donny Doreen<br />
OConnell<br />
bonny<br />
11<br />
97 5 59 85<br />
17 85 20 357 00<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 4807 05<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
08 12<br />
<strong>Pickering</strong><br />
2011<br />
Contact Person<br />
Last Name<br />
First Name<br />
Rutland<br />
Edward<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
1024 Rouge Valley Drive<br />
Province<br />
Postal Code<br />
<strong>Pickering</strong><br />
On L1 V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
666 905 2720 ext 905 666 1042 edarenaudrutland com<br />
9503P 2010101 Page 8 <strong>of</strong> 8
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CHARTERED ACCOUNTANTS<br />
AUDITOR S REPORT<br />
TO<br />
JenniferOConnell<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> JenniferOConnell candidate for the campaign period <strong>of</strong> January 4 2010 to<br />
December 31 2010 for the election held on October 25 2010 These financial statements are the<br />
responsibility <strong>of</strong> Jennifer OConnell candidate Our responsibility is to express an opinion<br />
financial statements based upon our audit<br />
on these<br />
Except as explained in the following paragraph<br />
generally accepted auditing standards Those standards require that we plan and perform an audit to obtain<br />
we conducted our audit in accordance with Canadian<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
the amounts and disclosures in the financial statement An<br />
examining on a test basis evidence supporting<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation<br />
<strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting<br />
records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from January 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit<br />
and the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHA<br />
FRED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 19 2011<br />
Marc A Renaud<br />
Edward Rutland<br />
307 High Street Whitby Ontario LIN 5H7 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario L1V 4N7<br />
Tel905 666 2720 Fax 905 666 1042 Tel 509 905 3023 Fax 905 6895 509<br />
mare@renaudrutland com<br />
ed@renaudrutland com
Ministry <strong>of</strong> Municipal Affairs<br />
l Ontario and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 04 to 2010 12 31<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
OConnell Jennifer<br />
I<br />
C<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1596 Seguin Square<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L 1 V 6T4<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Regional Councillor<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
905 420 2282 904 420 2282 jenniferocorulell<br />
@sympatico ca<br />
BOX B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
One<br />
1 My spending limit as issued by clerk<br />
Is was 23 275<br />
2 Surplus or deficit from previous election<br />
1663 24<br />
3 Total contributions received from Schedule 1<br />
22 721 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
Is 22 035 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 1393 0<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
23 428 00<br />
7 Election campaign surplus deficit from current election from Box E<br />
707 00<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
Is<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
i<br />
Box CStatement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 04 2010 12 31<br />
JENNIFEROCONNE LL<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate 900<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 21 289 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1 Inventory from previous campaign 532 00<br />
2<br />
3<br />
Total Campaign Period Income 22 721 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 338 00<br />
Bank charges 105 00<br />
Brochures 7600<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3 532 00<br />
Nomination filing fee<br />
Office expenses 577 00<br />
Phone and or Internet 660 00<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 2306 00<br />
Signs 5710 00<br />
Other provide full details<br />
1 Promotion 4207 00<br />
2<br />
3<br />
Subtotal 22 035 00 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 1000<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation notices 393 00<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
1393 00 C3<br />
Total Campaign Period Expenses C2 C3 Is 23 428 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 707 00<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 293 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
F 293 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 1000<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Is 1000<br />
Box E Statement <strong>of</strong>Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 707 00 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction 1663 00 E2<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
E2<br />
Total Determination<br />
E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I JenniferOComlell<br />
<strong>Pickering</strong><br />
financial statements and attached supporting<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the<br />
C i OF 1y<br />
on yyyy mm dd aczlk 0 a<br />
OCcrzr y1i<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
ignature<br />
<strong>of</strong> Candidate<br />
aQ o I C 9 1 Q 3<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
USA DIANNE HARKER<br />
aCommissionereM<br />
RegionsiMunicipality<br />
<strong>of</strong>Durharn<br />
forTheConx ation<strong>of</strong>the<br />
<strong>City</strong> <strong>of</strong> lickerling<br />
Expires January 28 2012<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1 Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 900<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse I 21 249 23<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse Is<br />
00 40<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 22 189 23<br />
Total contribution from anonymous sources 1113<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment Total 8250 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
8<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment Total 10 850 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment Total 214923<br />
Total Part II Contributions<br />
i21 249<br />
23 9503P 2010 01 Page 5 <strong>of</strong>
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
213<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2113 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010101 Page 6 <strong>of</strong> 8
i<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
rnm dd<br />
Bag Sign<br />
Frames 2006 09 27 Arrow Plastics 125 50 62 50<br />
Bag Signs 2006 09 27 Arrow Plastics 195 50 50 97<br />
Large Signs 2006 10 31 Jason Logrippo 17 50 20 350 00<br />
Web Domain 2006 07 26 Netfirms com 22 13 1 22 13<br />
Total Value <strong>of</strong> Inventory from Previous Campaign Used in Candidate s Campaign 532 13<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Bag Signs<br />
with Frames 2010 09<br />
Avenue Road 495 314 1554 30<br />
Advertising<br />
Coroplast Signs 2010 09 15 Print Fast 12 18 90 1096 20<br />
Magnetic Car Sign 15 2010 09 Print Fast 50 00 4 200<br />
Web Domain 2010 02 13 Netfirms com 59 70 1 70 59<br />
Rebar 201 010<br />
The Buckley Group 300 90 270 00<br />
Data 2010 07 27 7514433 Canada Corp 05 10 000 500<br />
Rebar 2010 09 15 The Buckley Group 400 105 420 00<br />
Magnets 2010 09 13 Clarington Promotions 029 1000 290 00<br />
Campaign<br />
Campaign<br />
Jackets 201 04 14 Giant Tiger Donny<br />
DoreenOConnell<br />
Shirts 2010 07 Donny Doreen<br />
OConnell<br />
11 97 5 59 85<br />
17 85 20 357 00<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
4807 05<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auclitdr s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date YYYY mm dd<br />
<strong>Pickering</strong> 2011 03 22<br />
Contact Person<br />
Licence No<br />
Last Name<br />
First Name<br />
Rutland Edward<br />
oc2<br />
Address<br />
Suite Unit No Street No Street Name<br />
1024 Rouge Valley Drive<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1 V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
666 905 2720 ext 666 905<br />
1042 ed@renaudrutland com<br />
9503P 2010101 Page 8 <strong>of</strong> 8
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Ministry <strong>of</strong> Municipal<br />
Ontario Affairs<br />
and Housing<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 821<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a<br />
regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Registrant Candidate<br />
Last Name First Name Mid<br />
0 ch 10Cf r in fcr<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
59 Sle<br />
Province<br />
Initial<br />
Postal Code<br />
P n T L I 1 tv Vi<br />
Telephone No incl area co e Fax No Email Address<br />
Business Home C Qo CcYI<br />
P05<br />
400QQ8 ZD<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the Ward<br />
question for which the registrant incurred expenses<br />
name or no if any<br />
Name<br />
Municipality<br />
Declaration<br />
the candidate registrant mentioned above hereby give notice<br />
a d clare to the clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
Declared before me<br />
attheC<br />
<strong>of</strong><br />
in the<br />
CKc r v<br />
Y<br />
<strong>of</strong><br />
Lu yyz<br />
this day <strong>of</strong> portrn rt 201<br />
Signature <strong>of</strong> Clerk<br />
Signature<br />
ct<strong>of</strong> fo<br />
<strong>of</strong> Candidate Registrant<br />
ao<br />
Date yyyy mm dd Dat yyyy mdd<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en frangais
fP cco cyixn<br />
l Warren C Hurren CA<br />
Neil SinclairBA CA<br />
Don MacIntyre B MATH CA<br />
August 10 2011<br />
Campaign<br />
1659 Goldenridge Road<br />
<strong>Pickering</strong> Ontario<br />
L1V 7J5<br />
<strong>of</strong> Bill McLean<br />
Dear Mr McLean<br />
We are pleased<br />
to enclose herewith three copies<br />
<strong>of</strong> the Financial Statement Form 4<br />
As your campaign period was extended this report covers the period from January 6 2010 to June 30<br />
2011 This report includes all financial transactions previously reported upon in the initial filing as<br />
well as the transactions from January 1 2011 to June 30 2011<br />
As the campaign contributions and the expenses are still less than 10 000 an audit report<br />
required<br />
is still not<br />
There is a surplus <strong>of</strong> 363 55 This is to be paid to the Clerk <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>Pickering</strong> This<br />
supplementary filing is to be filed with the Clerk by 200 pm on Friday September 30 2011<br />
We trust that you will find the foregoing<br />
in order<br />
Sincerely<br />
HURREN SINCLAIR MACINTYRE CHARTERED ACCOUNTANTS<br />
Neil Sinclair B A<br />
Licensed Public Accountant 16306<br />
NSkh<br />
Encl<br />
PO BOX 458 PICKERING ONTARIO L1 V 2R7 TEL 905 683 8856 FAX 905 683 3428
aj<br />
Ontario<br />
Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 06 to 2011 06 30<br />
Primary filing reflecting finances to December 31 or 45t day after voting day in aby election<br />
Supplementary filing including finances after December 31 or 45ti day after voting day in a by election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
McLean Bill R<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1659 Goldenridge Rd<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1 V 7J5<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
567 416 1055 905 839<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
9177 bmclean<br />
qlcity<strong>of</strong>pjckering com<br />
Regional Councillor Ward 2<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 19 154 20<br />
2 Surplus or deficit from previous election 103 21<br />
3 Total contributions received from Schedule 1 7150<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 5882 45<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 904 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 6786 45<br />
7 Election campaign surplus deficit from current election from Box E 363 55<br />
8 Contributions refunded to candidate or spouse from Box E 00<br />
9 Amount paid to clerk from Box E 363 55<br />
9503P 2010101<br />
C Queen s Printer for Ontario 2010 Disponibte en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 06 2011 06 30 Bill McLean<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 00<br />
Contributions from spouse <strong>of</strong> candidate 0<br />
All other contributions 7150 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income 00<br />
Other provide full details<br />
1 i<br />
2<br />
3 i<br />
Total Campaign Period Income Is 7150 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 945 77<br />
Bank charges 169 71<br />
Brochures 180246 1<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing<br />
00<br />
fee 100<br />
Office expenses 2157 05<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1 Meals 707 46<br />
2<br />
3<br />
Subtotal 5882 45 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting<br />
and audit 904 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3 I<br />
Other provide full details<br />
1<br />
2<br />
3 I<br />
Subtotal<br />
Is 904 00 C3<br />
Total Campaign Period Expenses C2 C3 Is 6786 45 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 363 55<br />
9503P 2010101 Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash 974 76<br />
Accounts receivable 1500<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 2474 76<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 2111<br />
1<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities 2111<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 363 55 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 S 363 55<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus 00<br />
Total Determination<br />
Is 363 55 E3<br />
E2<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
<strong>Pickering</strong><br />
L<br />
e clt<br />
a candidate in the municipality <strong>of</strong><br />
financial statements and attached supporting<br />
C er i V a hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the C p P 1CKtL wc<br />
on<br />
yyyy mm dd 20 t 1 6 8 1 5<br />
b<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature<br />
<strong>of</strong> Candidate<br />
ao I I l O S t5 DEBBIE M SHIELDS CITY CLERK<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 1121<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010101 Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate 00<br />
Contribution from 00<br />
spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
7150 00<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or<br />
00<br />
spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 16 S<br />
Is<br />
7150 00<br />
1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Steve De Guise 139 Indian Lake Road RR 1 Elgin Ontario KOG lEO 750 00<br />
Andrew Di Lorenzo 18 68 Millwick Drive North York Ontario N19L lY3 500<br />
Nick Di Lorenzo 18 68 Millwick Drive North York Ontario M91 1Y3 500<br />
Kenneth Rovinelli 1163 Old Post Drive Oakville Ontario L6M IA5 750 00<br />
I Petrovich 24 BeasleN Drive Richmond Hill Ontario L4C V2 750 00<br />
is<br />
Is<br />
I<br />
I<br />
Additional information is listed on separate supplementary attachment Total 3250 00<br />
9503P 2010101 Page 4 <strong>of</strong> 8
I<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
The Bench Press Ltd<br />
OA Creative Outdoor<br />
Advertising<br />
Picore Holdings Ltd<br />
2402 Stouffville Road RR 1<br />
Gormlev ON LOH GO<br />
80 Queen Street<br />
Kingston<br />
ON K7K 6W7<br />
David R Gray Liz Gayford 750 00<br />
Kim Donovan Kim Donovan 750 00<br />
Moroan s Port Restaurant<br />
1289 Wharf Stret<br />
Inc <strong>Pickering</strong><br />
ON L1 W 1 A2<br />
Todd Morgan Ralph Morgan 750 00<br />
Toronto Police<br />
Association<br />
180 Yorkland Blvd<br />
Toronto ON M2 1 1 RS<br />
Mike McCormide Tom Foulds 750 00<br />
International Brotherhood<br />
<strong>of</strong> Electrical Workers<br />
Local 894<br />
80 Lake Road Unit 3<br />
Bowmanville ON L1C 4P8<br />
Randy ONeill Randy<br />
ONeill 400<br />
Bayfield Realty Advisors 2300 Yonge Street 904 Harold Spring Harold Spring X00<br />
Inc<br />
Toronto ON M4P 1 E4<br />
2143087 Ontario AHK 2985 Drew Rd Palwinder Singh Palwinder Singh<br />
Group Mississauga ON L4T OA4 Verraich Verraich 150 00<br />
Additional information is listed on separate supplementary attachment Total 3750 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
1<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010101 Page 5 <strong>of</strong> 8
Schedule 2<br />
Date<br />
Fund Raising Function<br />
Additional schedule for each event or<br />
activity<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
12B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 21113 include in Schedule 1<br />
IS<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5 I<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
I S<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
IS<br />
Part IV<br />
Venue<br />
Expenses Related to<br />
Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
I<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010101 Page 6 <strong>of</strong> 8
i<br />
I<br />
i<br />
dd<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
i<br />
I<br />
I Total Value<strong>of</strong> Inventory from Previous<br />
Campaign Usedin Candidate s<br />
Campaign Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong><br />
Campaign Description Date Acquired Supplier Unit Value Quantity Total<br />
Value yyyy mm<br />
iiTotal Value <strong>of</strong> Inventory<strong>of</strong> Campaign Goods<br />
and Materials 9503P 2010101 Page 7
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Table 2 Monetary Contributions from unions or corporations<br />
supplementary list<br />
NAME ADDRESS President Cheque Amount<br />
Durham Region<br />
74 Anders Drive<br />
or<br />
Business<br />
Manager<br />
Heavy Port Perry ON Wayne Bruce Wayne<br />
Signatory<br />
Contractors L9L 1T5 Lvnne Siset<br />
Association<br />
Bruce 150 00<br />
Total
eVW l l<br />
Warren C Hurren CA<br />
Neil SinclairBA CA<br />
Don MacIntyre B MATH CA<br />
March 9 2011<br />
Mr Bill McLean<br />
1659 Goldenridge Road<br />
<strong>Pickering</strong> Ontario<br />
LIV 7J5<br />
Dear Mr McLean<br />
Please find enclosed two copies<br />
<strong>of</strong> the Financial Statement Form<br />
expenses pertaining to the 2010 municipal campaign<br />
4 reporting<br />
the contributions and<br />
This report covers the period from January 6 2010 to December 31 2010<br />
This report must be signed on page 3 in the presence <strong>of</strong> the Clerk prior to 200 pm on March 25<br />
2011<br />
Sincerely<br />
HURREN SINCLAIR MACINTYRE CHARTERED ACCOUNTANTS<br />
Neil Sinclair<br />
B<br />
vCA<br />
Licensed Public Accountant 16306<br />
NS kh<br />
Encl<br />
PO BOX 458 PICKERING ONTARIO L1 V 2R7 TEL 905 683 8856 FAX 905 683 3428
tOntario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 12010 01 06 to 2010 12 31<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
McLean Bill R<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
<strong>Pickering</strong><br />
1659 Goldenridge Rd<br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
567 416 1055 905 839<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
ON<br />
Postal Code<br />
L 1 V 7J5<br />
9177 bmclean@city<strong>of</strong>pickering com<br />
Regional Councillor Ward 2<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk Is 19 154 20<br />
was<br />
2 Surplus or deficit from previous election 103 21<br />
3 Total contributions received from Schedule 1 4650 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C Is 5822 75<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 565 00<br />
Is<br />
6 Total <strong>of</strong> all campaign expenses from Box C 6387 75<br />
7 Election campaign surplus deficit from current election from Box E 1737 75<br />
8 Contributions refunded to candidate or spouse from Box E 00<br />
9 Amount paid to clerk from Box E I<br />
00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en franrais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 06 2010 12 31 Bill McLean<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 00<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions 4650 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 00<br />
Interest income 00<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income 4650 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
945 77<br />
Bank charges<br />
1 10 01<br />
Brochures 1802 46<br />
Interest on loan<br />
Inventory<br />
contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee 100<br />
Office expenses<br />
2157 05<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1 Meals<br />
707 46<br />
2<br />
3<br />
C2<br />
Subtotal 5822 75<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 565 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
related to recounts<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 565 00 C3<br />
Total Campaign Period Expenses C2 C3 Is 6387 75 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 1737 75<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash 533 65<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
533 65<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 271 40<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
271 40<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus<br />
or Deficit<br />
75 E1<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 1737<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 1637 75<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
00<br />
Total Determination<br />
1637 75 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
a candidate in the municipality <strong>of</strong><br />
P ck r r G hereby declare that to the best <strong>of</strong> my knowledge<br />
financial statements and attached supporting schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the C O P1 GKer i G<br />
on<br />
yyyy mm dd 20 l i 3 1 1<br />
and belief that these<br />
E2<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature <strong>of</strong> Candidate<br />
OOlr 03 l t<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
9503P 2010<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 90<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
and services where value exceeds 100<br />
include all goods<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
00<br />
00<br />
4650 00<br />
include all goods and services where value is 100 or less 00<br />
do not include contributions from candidate or spouse<br />
i<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 4650 00<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 1 B<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name<br />
Address<br />
Amount<br />
Steve De Guise 139 Indian Lake Road RR 1 Elgin Ontario KOG 1 EO 750 00<br />
Additional information is listed on separate supplementary attachment Total 750 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
The Bench Press Ltd<br />
OA Creative Outdoor<br />
Advertising<br />
2402 Stouffville Road RR 1<br />
David R Gray Liz Gayford<br />
750 00<br />
Gormley ON LOH 1GO<br />
Picore Holdings Ltd<br />
80 Queen Street<br />
Kingston<br />
ON K7K 6W7<br />
Kim Donovan Kim Donovan 750 00<br />
Morgan s Port Restaurant 1289 Wharf Stret Todd Morgan Ralph Morgan<br />
750 00<br />
Inc<br />
<strong>Pickering</strong> ON L1 W 1 A2<br />
Toronto Police<br />
Association<br />
180 Yorkland Blvd<br />
Toronto ON M2 1 1 R5<br />
Mike McCormide Tom Foulds 750 00<br />
International Brotherhood<br />
<strong>of</strong> Electrical Workers<br />
Local 894<br />
380 Lake Road Unit 3<br />
Bowmanville ON L1C 4P8<br />
Randy ONeill Randy ONeill 400<br />
Bayfield Realty Advisors 2300 Yonge Street 4904 Harold Spring Harold Spring 200<br />
Inc<br />
Toronto ON M4P 1 E4<br />
2143087 Ontario AHK 2985 Drew Rd Palwinder Singh Palwinder Singh<br />
150 00<br />
Group Mississauga ON L4T OA4 Verraich Verraich<br />
Additional information is listed on separate supplementary attachment Total 3750 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
213<br />
Part I Ticket Revenue<br />
Lines 2A x 213 include 1<br />
in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Sdhedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials <strong>of</strong> The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
Province<br />
Postal Code<br />
Telephone No incl area code<br />
Fax<br />
ext<br />
No<br />
Email Address<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
i<br />
I<br />
Table 2 Monetary Contributions from unions or corporations<br />
supplementary list<br />
NAME ADDRESS President Cheque Amount<br />
Durham Region<br />
or<br />
Business<br />
Manager<br />
74 Anders Drive<br />
Signatory<br />
Heavy<br />
Port Perry ON Wayne Bruce Wayne Bruce 150 00<br />
Contractors L9L 1T5 Lynne Siset<br />
Association<br />
Total<br />
S3IM
Ministry <strong>of</strong> Municipal<br />
Ontario Affairs<br />
and Housing<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 821<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Registrant Candidate<br />
Last Name First Name Middle<br />
171<br />
Mailing Address<br />
Suite Unit No Street No Street Nam<br />
Clty TowPI<br />
I N Z 106e<br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
r<br />
Home<br />
Postal Code<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the Ward<br />
question which the registrant incurred expenses<br />
name or no if any<br />
Name <strong>of</strong> Municipality<br />
Declaration<br />
I<br />
LcC is<br />
the candidate registrant mentioned above hereby give notice<br />
and declare to the clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
Declared before me<br />
at the<br />
C<br />
<strong>of</strong><br />
P G V G<br />
in the<br />
R or <strong>of</strong><br />
this day <strong>of</strong> p c G vr o r<br />
20 to<br />
Signature <strong>of</strong> Clerk<br />
Signature<br />
<strong>of</strong> Candidate Registrant<br />
oa 20o Zo 2<br />
Date yyyy mm dd<br />
Date yyyy mm dd<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en frangais
kUd<br />
ttan<br />
CHARTERED ACCOUNTANTS<br />
AUDITOR S REPORT<br />
TO<br />
Rick Johnson<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Rick Johnson candidate for the campaign period <strong>of</strong> March 4 2010 to December<br />
31 2010 for the election held on October 25 2010 These financial statements are the responsibility <strong>of</strong><br />
Rick Johnson candidate Our responsibility is to express an opinion on these financial statements based<br />
upon our audit<br />
Except as explained in the following paragraph we conducted our audit in accordance with Canadian<br />
generally accepted auditing standards Those standards require that we plan and perform an audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
examining on a test basis evidence supporting the amounts and disclosures in the financial statement An<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation<br />
<strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from March 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit<br />
and the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS<br />
LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 15 2011<br />
Marc A Renaud<br />
Edward Rutland<br />
307 High Street Whitby Ontario LIN 5H7 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario LI V 4N7<br />
Tel905 666 2720 Fax 905 1042 666<br />
Tel905 3023 509 Fax 509 905 6895<br />
marc @ renaudrutland com<br />
ed@renaudrutiand com
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 03 04 to 2010 12 31<br />
Primary filing reflecting finances to December 31 or 45h day after voting day in a by election<br />
Supplementary filing including finances after December 31 or 45h day after voting day in aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Johnson Rick J<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
3730 Brock Road<br />
<strong>City</strong> Town<br />
Province<br />
Postal Code<br />
<strong>Pickering</strong><br />
ON L 1 Y I A2<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 649 2295 866 491<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Regional<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
2295 sjohnsonl@look ca<br />
Councillor ward 3<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 26 306 00<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1 33 951 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 26 302 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 7303 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 33 605 00<br />
7 Election campaign surplus deficit from current election from Box E 346 00<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E 346 00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 03 04 2010 12 31 Rick Johnson<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 33 951 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income Is 33 00<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 3712 00<br />
Bank charges<br />
59 00<br />
Brochures 3562 00<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted 1224 00<br />
Nomination filing fee<br />
Office expenses 2386 00<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 4572 Signs 7486 00<br />
Other provide full details<br />
1 Promotion 1750 00<br />
2 Travel 1093 00<br />
3 Postage 458 00<br />
Subtotal 26 302 00 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 800<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation notices 6103 00<br />
Expenses<br />
1<br />
2<br />
3<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1 Accounting<br />
2<br />
3<br />
services 400<br />
Subtotal 7303 00 C3<br />
Total Campaign Period Expenses C2 C3 Is 33 605 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 Is 346 00<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
l<br />
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 2074 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 2074 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 1729 00<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities Is 1729 00<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
E2<br />
346 00 E1<br />
00 E2<br />
346 00<br />
Total Determination Is<br />
346 00 E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I Rick Johnson<br />
<strong>Pickering</strong><br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
00<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
Municipality <strong>of</strong> <strong>Pickering</strong><br />
on yyyy mm dd<br />
Gf292<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
ignature<br />
aollIC<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
l<br />
<strong>of</strong> Candidate<br />
vA DIANE HARKER<br />
Gonlmissioner etc Regional Municipality<br />
f Durham forThe Corporation <strong>of</strong> the<br />
V <strong>of</strong> <strong>Pickering</strong><br />
1011res January 28 2012<br />
9503P 2010<br />
Page 3 or 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
i<br />
Contribution from spouse<br />
Total from each single contributor totalling<br />
more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or 33 951 00<br />
spouse<br />
Total from each single contributor totalling 100<br />
or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 33 951 00<br />
Total contribution from anonymous sources 113<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 16<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is fisted on separate supplementary attachment Total 10 901 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment Total<br />
23 050 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions 33 951 00<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity heldis are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
213<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2121 include in Schedule 1<br />
Is<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
y mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
<strong>Pickering</strong><br />
Contact Person<br />
Last Name<br />
First Name<br />
Date yyyy mm dd<br />
2011 03 12<br />
Licence No<br />
Gt 2<br />
Rutland Edward ll<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
<strong>Pickering</strong><br />
1024 Rouge Valley Drive<br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
905 666 2720 ext 905 666 1042<br />
On<br />
Postal Code<br />
L1 V 4N7<br />
9503P 2010101 Page 8 <strong>of</strong> 8
RICK JOHNSON LIST OF CONTRIBUTORS<br />
2010 Company Name Address <strong>City</strong> and Province Postal Code President or Manager<br />
Jun 02 Bench Press Limited 2402 Stouffville Road Box 245 Gormley Ontario LOH IGO D Grey 750 00<br />
Jun 02 2143087 Ontario Limited 2985 Drew Road Mississauga Ontario L4T OA1 200<br />
Jul 15 Metrus 30 Floral Parkway Suite 300 Concord Ontario L4K 4112 F Degasperis 500<br />
Jul 15 Jodee Truck Leasing 90 Promelia Court Markham Ontario L3S 3S4 905 201 0080 750 00<br />
Jul 15 Invar 220 Duncan Mill Road Ste301 Toronto Ontario M313 315 D Miklas 750 00<br />
Jul 15 Heather Glen 5240 Lakeridge Road Ashburn Ontario LOB 1AO B Guy 500<br />
Jul 15 Sundial 4576 Yonge St Ste 500 Toronto Ontario M2N 14 61 E Tatu 750 Jul 15 Lebovic Box 1240 Stouffville Ontario L4A 8A2 J Lebovic 750 00<br />
Jul 23 Marchar Holdings 23 Lesmill Road Ste 111 Toronto Ontario M36 3136 500<br />
Jul 23 F Reisman and Assoc 4800 Sheppard Ave E Unit 118 Toronto Ontario MIS 4N5 F Reisman 500<br />
Jul 29 Canadian Tire 1735 <strong>Pickering</strong> Parkway <strong>Pickering</strong> Ontario L1V 7C7 B Grey 250 00<br />
Aug 06 SRR Bay Ridges 160 Ferrand Drive Ste 801 Toronto Ontario M3C 3E5 S Warsh 750 00<br />
Aug 06 Picore Holdings 80 Queen Street Kingston Ontario K7K 6W7 A Silverthorne 750 Aug 21 Bitondo Market RR 1 Locust Hill Ontario LOH 10 L Bitondo 750 00<br />
Aug 21 Binns 333 Kingston Road <strong>Pickering</strong> Ontario L1V 1A1 R Binns 300<br />
Aug 26 Viva <strong>Pickering</strong> 3845 Bathurst St Ste 206 Toronto Ontario M3H 3N2 250 00<br />
Sep 17 2143087 Ontario Limited 2985 Drew Road Mississauga Ontario L4T OA1 150 Sep 17 Electrical Workers 353 1377 Lawrence Ave East Toronto Ontario M3A 3138 T Dorgan 500<br />
Sep 17 Cole Engineering 100 Renfrew Dr Ste 100 Toronto Ontario L3R 9R6 S Cole 250 00<br />
Sep 17 Malone Given Parsons 140 Renfrew Dr Ste 201 Markham Ontario L3R 683 D Given 750 00<br />
Sep 17 Electrical Workers 894 T Dorgan 400<br />
Sep 17 Royal Auto Body 971 Alliance Road <strong>Pickering</strong> Ontario LIW 3M8 R Wagner 500<br />
Sep 17 Can Sort Recycling 1048 Toy AvenueSte 102 <strong>Pickering</strong> Ontario L1W 3PI R Wiltshire 500<br />
Oct 01 Sabourin Kimble 110 Old Kingston Road Ajax Ontario LIT 2Z9 R Saborin 250 00<br />
Oct 01 Westhall Investments 1815 Ironstone Manor Ste 1 <strong>Pickering</strong> Ontario L1W 3W9 A Libfield 750 Oct 01 Don Mills Golf Box 4080 Markham Industrial Markham Ontario L3R 9118 L McArthur 400<br />
Oct 01 First Towing 91 Notion Road Ajax Ontario LIS 6K8 J Walsh 750 Oct 01 Presidential 141 York Mills Road North York Ontario M21 IK4 250 00<br />
Oct 01 Sernas Group 110 Scotia Court Unit 41 Whitby Ontario L1N 8Y7 R Webster 300<br />
Oct 01 TACC 270 Chrislea Road Woodbridge Ontario 141 BAB S Degasperis 500<br />
Oct 04 Walker Head 1315 <strong>Pickering</strong> Pky Ste 800 <strong>Pickering</strong> Ontario LIV 7G5 M Head 300<br />
Oct 12 Brockington Plaza 17 Portsmith Road North York Ontario M21 2W7 Z Schmerler 500<br />
Oct 12 Maylar Construction 9488 McCowan Road Markham Ontario L3P 313 M Larkin 750 Oct 12 Bayfield Realty 2300 Yonge St Unit 904 Toronto Ontario M4P IE4 V Brijbassi 250 00<br />
Oct 12 Louisville Homes 11 Colonel Danforth Tr Toronto Ontario M1C 1P8 N Lazaridis 750 00<br />
Oct 12 Mattamy Homes 2360 Bristol Circdle Oakville Ontario L6H 6M5 R Miller 400<br />
Oct 12 Alfin Financial 44 Upjohn Road Toronto Ontario M36 2W1 750 00<br />
Oct 12 Fourteen Estates 96 Cawkers Cove Road Port Perry<br />
Ontario 191 1R6 R Rondeau 200<br />
Oct 12 Masseys 774 Liverpool Rd S <strong>Pickering</strong> Ontario L1W 1119 D Argiro 250 00<br />
Oct 12 Hard Co 625 Conlin Rd Whitby Ontario LIR 2W8 B Harding 400<br />
Oct 20 Durham Heavy Contractors 1631 Bethesda Sideroad Richmond Hill Ontario L4E OG8 250 Oct 20 Parsons Brinckerh<strong>of</strong>f 488 Wellington St W Ste 202 Toronto Ontario M5V IE3 P Brickerh<strong>of</strong>f 300<br />
Oct 20 NHD Developments 3700 Steeles Ave W Ste 800 Vaughan Ontario 141 8M9 661 416 6263 750 00<br />
Oct 20 Runnymede 1051 Tapscott Road Toronto Ontario MIX 1AI J Kaplan 750 00<br />
Oct 27 Rougemount Square 1550 Kingston Rd Ste 300 <strong>Pickering</strong> Ontario L1V 1C3 R Feldman 200<br />
Oct 27 <strong>Pickering</strong> Square 1550 Kingston Rd Ste 300 <strong>Pickering</strong> Ontario L1V 1C3 R Feldman 200<br />
Oct 27 <strong>Pickering</strong> Square 1550 Kingston Rd Ste 300 <strong>Pickering</strong><br />
Ontario L1V 10 R Feldman 200<br />
Nov 03 Local 46 Plumbers 936 Warden Ave Scarborough Ontario M1L 4C9 100<br />
Nov 03 870122 Ontario Ltd 34 Zaph Avenue Scarborough Ontario M1C 1M7 500<br />
23 050 00
Individual Donations<br />
Jul 151 MacKenzie 8 Cyril Richardson Court Uxbridge Ontario 1913 2A8 750 Jul 29 D James 45 Georgian Street Lindsay Ontario K9V 5117 100<br />
Aug 06<br />
N Cortellucci 137 Bowes Road Concord Ontario L4K 1113 750 7 Greenwood Ontario LOH 1HO 400<br />
Aug 06 L Fisher 2250 Hwy<br />
Aug 06 S De Guise 139 Indian Lake Road Elgin Ontario KOG 1E0 750 Aug 26 Kahn 150 00<br />
Sep 17 G Kepinska 1895 Clements Rd Unit 161 <strong>Pickering</strong> Ontario LiW 3V5 750 Sep 17 E Jerzykiewicz 1305 Wilson Av Apt 612 Downsview Ontario M3M 12 750 00<br />
Sep 17 H Trzcinski 86 Mountainberry Rd Brampton Ontario L6R 21 750 Sep 17 L Trzcinska 86 Mountainberry Rd Brampton Ontario L6R 217 750 Sep 17 K Trzcinski 86 Mountainberry Rd Brampton Ontario 161121 7 750 00<br />
Oct 01 S Graham 4 North Rd Whitevale Ontario LOH IMO 200<br />
Oct 01 L McArthur Box 4080 Markham Industrial Markham Ontario 13119138 350 00<br />
Oct 01 J Winberg 26 Breen Cres Willowdale Ontario M2P 1Z7 250 00<br />
Oct 12 B Jassal 1664 Fairfield Cres <strong>Pickering</strong> Ontario L1V 6H5 200<br />
Oct 12 B Kular 112 Sweetbriar Crt <strong>Pickering</strong> Ontario L1V 6112 400<br />
Oct 12 J Overzet 655 Audley Road South Ajax<br />
Ontario L1Z OC6 500<br />
Oct 12 V Gupta 562 Renforth Drive Etobicoke Ontario M9C 2N2 750 00<br />
Oct 20 B Cummings RR 2 <strong>Pickering</strong> Ontario L1V 2139 200<br />
Oct 20 B Kular 112 Sweetbriar Crt <strong>Pickering</strong> Ontario L1V 6112 350 Oct 27 R Bhullar 5326 Swiftcurrent Trail Mississauga Ontario 15112 11 201 Oct 27 H Agnitsch 750 00<br />
Nov 03 G Whalley 1926 Glenview Road <strong>Pickering</strong> Ontario L1V 1W8 100<br />
10 901 00<br />
33 951 00
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 82 1<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Registrant Candidate<br />
Last Name 71 First Name Middle Initial<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
3 12v c2 too<br />
Province<br />
GLkV5mo0 W<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Postal Code<br />
L f I t9co<br />
5 G<br />
Home<br />
r CinQSY<br />
6 Sbl I as 6 1 r aa1S I h<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the Ward<br />
question for which the registrant incurred expenses 2<br />
L t d via nc t v<br />
J<br />
Name <strong>of</strong><br />
niM<br />
Declaration<br />
name or no if any<br />
30 1A VVr the candidate registrant mentioned above hereby give notice<br />
and declare to the clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
Declared before me<br />
at the<br />
C<br />
<strong>of</strong>r t<br />
in the<br />
ot d<br />
02J4z<br />
this day <strong>of</strong> 20 J0<br />
Signature <strong>of</strong> Clerk ignatu <strong>of</strong> Candidate Registrant<br />
LIP<br />
Ito 12 ly<br />
Date yyyy mm dd<br />
Date yyyy mm dd<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en franpis
Please be advised that my Campaign concluded on December 31 2010 and therefore the extension <strong>of</strong><br />
Campaign P<br />
rind is completed<br />
Rick Joh<br />
son<br />
3730 Brock Road<br />
<strong>Pickering</strong> Ontario
i<br />
kaCHARTERED ACCOUNTANTS 5Or C Q I YKO rL<br />
a co r<br />
rQi Pe<br />
nd Cp n 1<br />
G 1212 eMen1 rI Ft i y U<br />
I<br />
3I av o<br />
AUDITOR S REPORT<br />
TO<br />
Rick Johnson<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Rick Johnson candidate for the campaign period <strong>of</strong> March 4 2010 to December<br />
31 2010 for the election held on October 25 2010 These financial statements are the responsibility <strong>of</strong><br />
Rick Johnson candidate Our responsibility is to express an on<br />
opinion these financial statements based<br />
upon<br />
our audit<br />
Except as explained in the following paragraph<br />
generally accepted auditing standards Those standards require that we plan and perform<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
we conducted our audit in accordance with Canadian<br />
an audit to obtain<br />
examining on a test basis evidence supporting<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation<br />
the amounts and disclosures in the financial statement An<br />
<strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
records in accordance<br />
the financial statements reflect the amounts recorded in the candidate s accounting<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might<br />
necessary had we been able to satisfy ourselves as to the completeness<br />
have determined to be<br />
<strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from March 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit<br />
and the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not<br />
require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 15 2011<br />
Mare A Renaud<br />
Edward Rutland<br />
307 High Street Whitby Ontario LIN 5H7 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario LI V 4N7<br />
Tel905 2720 666 Fax 905 1042 666<br />
Tel 509 905 3023 Fax 905 509 6895<br />
marc@renaudrutland com<br />
ed@renaudrutland com
Cltarl0 Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor s <strong>Report</strong><br />
L<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 03 04 to<br />
12010<br />
12 31<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<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
or 45th day after voting day in a by election<br />
Last Name First Name Middle Initial<br />
Johnson Rick J<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
3730 Brock Road<br />
Province<br />
Postal Code<br />
<strong>Pickering</strong><br />
ON L 1 Y I A2<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 649 2295 491 866<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
2295 sjohnsonl@look ca<br />
Regional Councillor ward 3<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 26 306 00<br />
2 Surplus or deficit from previous election Is<br />
3 Total contributions received from Schedule 1 Is 33 951 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 26 302 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 7303 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 33 605 00<br />
7 Election campaign surplus deficit from current election from Box E 346 00<br />
8 Contributions refunded to candidate or<br />
spouse from Box E<br />
9 Amount paid to clerk from Box E 346 00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible<br />
en franpais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 03 04 2010 12 31 Rick Johnson<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 33 951 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income 33 951 00<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 3712 00<br />
Bank charges<br />
59 00<br />
Brochures 3562 00<br />
Interest on loan<br />
Inventory<br />
Meetings<br />
contributed to candidate s campaign Schedule 3<br />
hosted 1224 00<br />
Nomination filing fee<br />
Office expenses 2386 00<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 4572 Signs 7486 00<br />
Other provide full details<br />
1 Promotion 1750 00<br />
2 Travel 1093 00<br />
3 Postage<br />
458 00<br />
Subtotal 26 302 00<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 800<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation<br />
Expenses<br />
1<br />
2<br />
3<br />
notices 6103 00<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1 Accounting services 400<br />
2<br />
3<br />
Subtotal IS 7303 00<br />
C3<br />
Total Campaign Period Expenses C2 C3 Is 33 605 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 346 00<br />
9503P 2010101 Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 2074 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets 2074 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 1729 00<br />
Borrowings overdraft<br />
Other provide full details<br />
2<br />
3<br />
Total Liabilities Is 1729 00<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus<br />
or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
346 00 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the 00 E2<br />
same jurisdiction<br />
Surplus or deficit for the 346 00<br />
campaign period E1 E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
00<br />
Total Determination Is 346 00 E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I Rick Johnson<br />
<strong>Pickering</strong><br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
Municipality <strong>of</strong> <strong>Pickering</strong><br />
on yyyy mm dd oQ1 C oZ 6<br />
LYt<br />
Signature <strong>of</strong> Clerk or Commissioner Oignature<br />
ac kI 103 0 5<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
C<br />
<strong>of</strong> Candidate<br />
A DIANNE HARKER<br />
Cor pissiioner etc<br />
RegionalMunidpality<br />
t Uufitara forTile Corporation <strong>of</strong> the<br />
ty <strong>of</strong> <strong>Pickering</strong><br />
alresJanuarv 28 2012<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or<br />
33 951 001<br />
spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution<br />
33 951 00<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 16<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name<br />
Address<br />
Amount<br />
Additional information is listed on separate supplementary attachment Total 10901 00<br />
9503P 2010101<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory<br />
Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment Total 23 050 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions 33 951 00<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
2A<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete<br />
Number <strong>of</strong> tickets sold<br />
breakdown <strong>of</strong> all ticket sales<br />
2B<br />
Part 1 Ticket Revenue<br />
Lines 2A x 26 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
5<br />
6<br />
7<br />
8<br />
Total Pan I Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses<br />
Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description<br />
Date Acquired Supplier Unit Value Quantity Total Value<br />
y mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
ymm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
I<br />
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
<strong>Pickering</strong><br />
Contact Person<br />
Last Name<br />
First Name<br />
Date yyyy mm dd<br />
2011 03 12<br />
Licence No<br />
Rutland Edward 1h1 Z<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
<strong>Pickering</strong><br />
1024 Rouge Valley Drive<br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
666 905 2720 ext 905 1042 666<br />
On<br />
Postal Code<br />
L1V 4N7<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
RICK JOHNSON LIST OF CONTRIBUTORS<br />
2010 Company Name Address <strong>City</strong> and Province Postal Code President or Manager<br />
Ontario LOH 1GO D Grey 750 00<br />
Jun 02 Bench Press Limited 2402 Stouffville Road Box 245 Gormley<br />
Ontario L4T OAl 200<br />
Jun 02 2143087 Ontario Limited 2985 Drew Road Mississauga<br />
Jul 15 Metrus 30 Floral Parkway Suite 300 Concord Ontario L4K 4132 F Degasperis 500<br />
Jul 15 Jodee Truck Leasing 90 Promelia Court Markham Ontario L3S 3S4 905 0080 201 750 00<br />
Jul 15 Invar 220 Duncan Mill Road Ste301 Toronto Ontario M313 315 D Miklas 750 00<br />
Jul 15 Heather Glen 5240 Lakeridge Road Ashburn Ontario LOB IAO B Guy 500<br />
Jul 15 Sundial 4576 Yonge St Ste 500 Toronto Ontario M2N 6N4 E Tatu 750 Jul 15 Lebovic Box 1240 Stouffville Ontario L4A 8A2 J Lebovic 750 00<br />
Jul 23 Marchar Holdings 23 Lesmill Road Ste 111 Toronto Ontario M313 3136 500<br />
Jul 23 F Reisman and Assoc 4800 Sheppard Ave E Unit 118 Toronto Ontario MIS 4N5 F Reisman 500<br />
Jul 29 Canadian Tire 1735 <strong>Pickering</strong> Parkway <strong>Pickering</strong> Ontario L1V 7C7 B Grey 250 00<br />
Aug 06 SRR Bay Ridges 160 Ferrand Drive Ste 801 Toronto Ontario M3C 3E5 S Warsh 750 00<br />
Aug 06 Picore Holdings 80 Queen Street Kingston Ontario OK 6W7 A Silverthorne 750 Aug 21 Bitondo Market RR 1 Locust Hill Ontario LOH 1JO L Bitondo 750 Aug 21 Binns 333 Kingston Road <strong>Pickering</strong> Ontario L1V 1A1 R Binns 300<br />
Aug 26 Viva <strong>Pickering</strong> 3845 Bathurst St Ste 206 Toronto Ontario M3H 3N2 250 00<br />
Sep 17 2143087 Ontario Limited 2985 Drew Road Mississauga Ontario L4T OAl 150 Sep 17 Electrical Workers 353 1377 Lawrence Ave East Toronto Ontario M3A 3P8 T Dorgan 500<br />
Sep 17 Cole Engineering 100 Renfrew Dr Ste 100 Toronto Ontario L3R 9R6 S Cole 250 00<br />
Sep 17 Malone Given Parsons 140 Renfrew Dr Ste 201 Markham Ontario 1311663 D Given 750 00<br />
Sep 17 Electrical Workers 894 T Dorgan 400<br />
Sep 17 Royal Auto Body 971 Alliance Road <strong>Pickering</strong> Ontario L1W 31VI8 R Wagner 500<br />
Sep 17 Can Sort Recycling 1048 Toy AvenueSte 102 <strong>Pickering</strong> Ontario LIW 3P1 R Wiltshire 500<br />
Oct 01 Sabourin Kimble 110 Old Kingston Road Ajax Ontario L1T 2Z9 R Saborin 250 00<br />
Oct O1 Westhall Investments 1815 Ironstone Manor Ste 1 <strong>Pickering</strong> Ontario L1W 3W9 A Libfield 750 00<br />
Oct Ol Don Mills Golf Box 4080 Markham Industrial Markham Ontario L3R 9R8 L McArthur 400<br />
Oct 01 First Towing 91 Notion Road Ajax Ontario LIS 6K8 J Walsh 750 Oct 01 Presidential 141 York Mills Road North York Ontario M21 1K4 250 00<br />
Oct OS Sernas Group 110 Scotia Court Unit 41 Whitby Ontario LIN 8Y7 R Webster 300<br />
Oct 01 TACC 270 Chrislea Road Woodbridge Ontario L4L 8A8 S Degasperis 500<br />
Oct 04 Walker Head 1315 <strong>Pickering</strong> Pky Ste 800 <strong>Pickering</strong> Ontario LIV 7G5 M Head 300<br />
Oct 12 Brockington Plaza 17 Portsmith Road North York Ontario M212W7 Z Schmerler 500<br />
Oct 12 Maylar Construction 9488 McCowan Road Markham Ontario L3P 313 M Larkin 750 00<br />
Oct 12 Bayfield Realty 2300 Yonge St Unit 904 Toronto Ontario M4P 1E4 V Brijbassi 250 00<br />
Oct 12 Louisville Homes 11 Colonel Danforth Tr Toronto Ontario M1C 1P8 N Lazaridis 750 00<br />
Oct 12 Mattamy Homes 2360 Bristol Circdle Oakville Ontario L6H 6M5 R Miller 400<br />
Oct 12 Alfin Financial 44 Upjohn Road Toronto Ontario M36 2W1 750 Oct 12 Fourteen Estates 96 Cawkers Cove Road Port Perry Ontario L9L 1R6 R Rondeau 200<br />
Oct 12 Masseys 774 Liverpool Rd S <strong>Pickering</strong> Ontario LIW 1R9 D Argiro 250 00<br />
Oct 12 Hard Co 625 Conlin Rd Whitby Ontario L1R 2W8 B Harding 400<br />
Oct 20 Durham Heavy Contractors 1631 Bethesda Sideroad Richmond Hill Ontario L4E OG8 250 Oct 20 Parsons Brinckerh<strong>of</strong>f 488 Wellington St W Ste 202 Toronto Ontario M5V 1E3 P Brickerh<strong>of</strong>f 300<br />
Oct 20 NHD Developments 3700 Steeles Ave W Ste 800 Vaughan Ontario 141 8M9 661 416 6263 750 Oct 20 Runnymede 1051 Tapscott Road Toronto Ontario MIX lAl J Kaplan 750 00<br />
Oct 27 Rougemount Square 1550 Kingston Rd Ste 300 <strong>Pickering</strong> Ontario L1V 1C3 R Feldman 200<br />
Oct 27 <strong>Pickering</strong> Square 1550 Kingston Rd Ste 300 <strong>Pickering</strong> Ontario L1V 1C3 R Feldman 200<br />
Oct 27 <strong>Pickering</strong> Square 1550 Kingston Rd Ste 300 <strong>Pickering</strong> Ontario LlV IC3 R Feldman 200<br />
Nov 03 Local 46 Plumbers 936 Warden Ave Scarborough Ontario MIL 4C9 100<br />
Nov 03 870122 Ontario Ltd 34 Zaph Avenue Scarborough<br />
Ontario M1C 1M7 500<br />
23 050 00
Individual Donations<br />
Jul 151 MacKenzie 8 Cyril Richardson Court Uxbridge Ontario L9P 2A8 750 Jul 29 D James 45 Georgian Street Lindsay Ontario K9V 51 17 100<br />
Aug 06 N Cortellucci 137 Bowes Road Concord Ontario L4K 11 13 750 00<br />
Aug 06 L Fisher 2250 Hwy 7 Greenwood Ontario LOH 1HO 400<br />
Aug 06 S De Guise 139 Indian Lake Road Elgin Ontario KOG 1EO 750 Aug 26 Kahn 150 00<br />
Sep 17 G Kepinska 1895 Clements Rd Unit 161 <strong>Pickering</strong> Ontario L1W 3V5 750 Sep 17 E Jerzykiewicz 1305 Wilson Av Apt 612 Downsview Ontario M31VI 12 750 00<br />
Sep 17 H Trzcinski 86 Mountainberry Rd Brampton Ontario L6R 217 750 Sep 17 L Trzcinska 86 Mountainberry Rd Brampton Ontario L6R 217 750 Sep 17<br />
K Trzcinski 86 Mountainberry Rd Brampton Ontario L6R 217 750 Oct 01 S Graham 4 North Rd WhitevaIe Ontario LOH 1MO 200<br />
Oct 01 L McArthur Box 4080 Markham Industrial Markham Ontario L3R 9R8 350 00<br />
Oct 01 J Winberg 26 Breen Cres Willowdale Ontario M2P 27 250 00<br />
Oct 12 B Jassal 1664 Fairfield Cres <strong>Pickering</strong> Ontario L1V 61 15 200<br />
Oct 12 B Kular 112 Sweetbriar Crt <strong>Pickering</strong> Ontario L1V 6R2 400<br />
Oct 12 J Overzet 655 Audley Road South Ajax Ontario L1Z OC6 500<br />
Oct 12 V Gupta 562 Renforth Drive EtobiCoke Ontario M9C 2N2 750 00<br />
Oct 20 B Cummings RR 2 <strong>Pickering</strong> Ontario L1V 2P9 200<br />
Oct 20 B Kular 112 Sweetbriar Crt <strong>Pickering</strong> Ontario L1V 6R2 350 00<br />
Oct 27 R Bhullar 5326 Swiftcurrent Trail Mississauga Ontario L5R 211 201 Oct 27 H Agnitsch<br />
750 00<br />
Nov 03 G Whalley 1926 Glenview Road <strong>Pickering</strong> Ontario L1V 1W8 100<br />
10 901 00<br />
33 951 00
J Ministry <strong>of</strong> Municipal Affairs<br />
Financial Statement Auditor<br />
Ontario and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 04 21 to 2011 06 30<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Rodrigues<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
750 Whitevale Rd RR1<br />
<strong>City</strong> Town<br />
Province<br />
Postal Code<br />
Locust Hill ON LOH 1 JO<br />
Peter<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 0476 201<br />
peter@yourvoicepickering ca<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Regional Councillor 3<br />
Name <strong>of</strong> Municipality<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was<br />
1 26 306 10<br />
2 Surplus or deficit from previous election Is<br />
3 Total contributions received from Schedule 1 Is<br />
18 923 22<br />
4 My total campaign expenses that were subject to the spending limit were from Box C Is 15 922 07<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 130 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 17 052 07<br />
7 Election campaign surplus deficit from current election from Box E 1871 15<br />
8 Contributions refunded to candidate or spouse from Box E Is 1871 15<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible<br />
en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 04 21 2011 06 30 Peter Rodrigues<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate 14 543 22<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 4380 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income Is 18 EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
449 10<br />
Bank charges<br />
77 85<br />
Brochures 3045 46<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee<br />
Office expenses 1902 81<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 10 446 85<br />
Other provide full details<br />
1<br />
2<br />
3<br />
22<br />
C1<br />
Subtotal<br />
C2<br />
15 922 07<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 130 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 130 00 C3<br />
Total Campaign Period Expenses C2 C3 Is 17 052 07 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is 1871 15<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
i BoxD Statement<strong>of</strong> Assetsand liabilities as at June 301<br />
2011<br />
Assets<br />
Cash 3122<br />
14 Accounts<br />
receivable Value<strong>of</strong> inventory retained from Schedule 4339<br />
30 Other provide full<br />
details<br />
1<br />
2<br />
3 Total Assets I7461<br />
44 Liabilities and Excess Deficiency<strong>of</strong> Income over<br />
Expenses Accounts<br />
payable 7461<br />
44 Borrowings<br />
overdraft Other provide full<br />
details<br />
1<br />
2<br />
3 Total Liabilities 7461<br />
44 BoxE Statement<strong>of</strong> Determination<strong>of</strong> Surplusor Deficit and Disposition <strong>of</strong><br />
Surplus PartI Determination<strong>of</strong> Surplusor<br />
Deficit Amount<strong>of</strong> excess deficiency<strong>of</strong> income over expenses from Box C1871 15<br />
E1 Deduct Any deficit carried forward bythe candidate from immediately preceding<br />
electionif the <strong>of</strong>fices are with respect to jurisdiction<br />
the same<br />
E2 Surplusor deficit forthe campaign period E1<br />
E2 Deduct Any refund<strong>of</strong> contributions to the candidateor spouse onlyif there is a surplus 1871<br />
Determination<br />
15 Total<br />
E3 Part II Disposition <strong>of</strong><br />
SurplusIf line E3 showsa surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who<br />
was responsible for the conduct <strong>of</strong> the<br />
election Surplus paid to the municipal clerk <strong>of</strong> the municipality<br />
<strong>of</strong> BoxF<br />
DeclarationI Peter<br />
Rodriguesacandidate inthe municipality<br />
<strong>of</strong> Ft C 1 rt G hereby declare that to the best <strong>of</strong>my knowledge and belief that<br />
these financial statements and attached pporting schedules are true and<br />
correct Declared before clerk or<br />
commissioner in<br />
theon yyyy mm ddQ O L<br />
1 Signature<strong>of</strong> Clerkor Commissioner Signature<strong>of</strong><br />
Candidate<br />
aol<br />
og Date Filed in the ClerksOffice yyyy mm<br />
dd DEBBIEM SHIELDS CITY<br />
CLERK CITYOF<br />
PICKERING EX OFFICIO<br />
COMMISSIONER PURSUANTTO SECTION 1<br />
2 OFTHE COMMISSIONERS<br />
FOR TAKING AFFIDAVITS<br />
ACT 9503P 2010 01 Page 3 <strong>of</strong>
Schedule 1<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate 14 543 22<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
2575 00<br />
1805 00<br />
Less Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 18 923 22<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 113<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Lorne Almack RR5 <strong>Pickering</strong> ON L 1 Y 1 A2 500<br />
Merna Burkholder RR2 Stn Main <strong>Pickering</strong> ON L IV 2P9 150 00<br />
Steve Manning<br />
2065 Blue Ridge Cres <strong>Pickering</strong><br />
ON L1X 2N5 500<br />
Donna Manning<br />
2065 Blue Ridge Cres <strong>Pickering</strong> ON L1X 2N5 500<br />
William P Wilder 40 King St W Toronto ON MSH 3Y2 500<br />
Robert Verbancic 283 Concession 3 <strong>Pickering</strong><br />
ON L1 V 2P8 300<br />
James G Robb 1 Braeburn Blvd Scarborough ON M1J 2P9 125 00<br />
Additional information is listed on<br />
separate supplementary attachment Total 2575 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on<br />
separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
2B<br />
Part I Ticket Revenue<br />
Lines 2A x 21B include<br />
in Schedule 1<br />
Is<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include<br />
in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Printed signs<br />
24 x 16 2010 09 14 Print Me Design Inc 509 400 2036 00<br />
Printed signs<br />
32 x 48 28 2010 09 Print Me Design Inc 69 14 70 1028 30<br />
Printed Signs<br />
24 x 12 12 2010<br />
Print Me Design Inc 255 500 1275 00<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 4339 30<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
<strong>Pickering</strong> 2011 09 21<br />
Contact Person<br />
Last Name<br />
Sinclair<br />
Address<br />
Suite Unit No Street No Street Name<br />
4 144 Old Kingston Road<br />
<strong>City</strong> Town<br />
Ajax<br />
First Name<br />
Neil<br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
683 905 8856 ext 224 905 683<br />
ON<br />
3428 nsinclair@hsmca com<br />
Licence No<br />
Postal Code<br />
LIT 2Z9<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
f<br />
INDEPENDENT AUDITORS REPORT<br />
Municipal Elections Act 1996 Section 78<br />
To Debbie Shields <strong>City</strong> Clerk<br />
We have audited the Statement <strong>of</strong> Assets and Liabilities as at June 30 2011 and the Statement <strong>of</strong><br />
Campaign Period Income and Expense and the Statement <strong>of</strong> Determination <strong>of</strong> Surplus<br />
or Deficit <strong>of</strong><br />
Peter Rodrigues candidate for the extended campaign period from April 21 2010 to June 30 2011<br />
relating to the election held on October 25 2010<br />
Candidate s Responsibility for the Financial Statements<br />
The candidate is responsible for the preparation and fair presentation<br />
accordance with the Municipal Elections Act 1996 Section 78<br />
candidate determines is necessary to enable the preparation<br />
material misstatement<br />
Auditors Responsibility<br />
whether due to fraud or error<br />
<strong>of</strong> these financial statements in<br />
and for such internal controls as the<br />
<strong>of</strong> financial statements that are free from<br />
Our responsibility is to express an opinion<br />
conducted our audit in accordance with Canadian generally accepted auditing<br />
standards require that we comply with ethical requirements and plan and perform<br />
on these financial statements based on our audit We<br />
standards Those<br />
the audit to obtain<br />
reasonable assurance about whether the financial statements are free from material misstatement<br />
An audit involves performing procedures<br />
the financial statements The procedures selected depend on the auditors judgment including the<br />
to obtain audit evidence about the amounts and disclosures in<br />
assessment <strong>of</strong> risks <strong>of</strong> material misstatement <strong>of</strong> the financial statements whether due to fraud or error<br />
In making those risk assessments the auditor considers internal control relevant to the candidate s<br />
preparation and fair presentation <strong>of</strong> the financial statements in order to design audit procedures that are<br />
appropriate in the circumstances but not for the purposes <strong>of</strong> expressing an on<br />
opinion the effectiveness<br />
<strong>of</strong> the candidate s internal control An audit also includes evaluating the appropriateness <strong>of</strong> accounting<br />
policies used and the reasonableness <strong>of</strong> accounting estimates made by the candidate as well as<br />
evaluating the overall presentation <strong>of</strong> the financial statements<br />
We believe that the audit evidence we have obtained is sufficient and appropriate to provide<br />
our qualified audit opinion<br />
a basis for<br />
Basis For Qualified Audit Opinion<br />
Due to the nature <strong>of</strong> the types <strong>of</strong> transactions inherent in an election campaign it is impracticable<br />
through auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods<br />
dI Lk17 7f1pL4eLIII YII<br />
C faiietnirm anJ
t<br />
O<br />
r r I and services and receiptsand disbursements<br />
Accordinglyour verification<strong>of</strong> these transactions<br />
was limitedto ensuring that the financial statements reflect the amounts recorded inthe accounting<br />
records<strong>of</strong> Peter Rodrigues candidatein accordance withthe accounting procedures established by<br />
the Municipal Elections Act 1996 and we were not ableto determine whetherany adjustments might<br />
surplus<br />
be necessaryto income and expenses assets or liabilitiesand<br />
deficit Qualified<br />
Opinion In our opinion except for the possible effects described in the Basis for Qualified Opinion<br />
paragraphthe financial statements present fairly inall material respects the financial<br />
s election campaign as at June 30 2011 and the income and expenses from the extended<br />
position <strong>of</strong>the candidate<br />
campaign period from April 21 2010 2010 to June 30 2011 andthe determination<strong>of</strong><br />
surplusor deficit and<br />
the disposition <strong>of</strong> surplusin accordance with the accounting treatment prescribed bythe<br />
Municipal Elections Act<br />
1996 Basis<strong>of</strong><br />
Accounting Without modifying our<br />
been preparedin accordance with The Municipal Elections Act 1996 to meetthe requirements<strong>of</strong> that<br />
opinion we draw attention to the fact these financial statements have<br />
Act As a result the financial statements may notbe suitablefor another<br />
purpose<br />
i4 HURREN SINCLAIR MACINTYRE CHARTERED<br />
ACCOUNTANTS September 21<br />
2011 Ajax
s <strong>Report</strong><br />
Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
000 must also attach an Auditor s <strong>Report</strong><br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong> 10<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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 04 21 to 2010 12 31<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Rodrigues<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
750 Whitevale Rd RRl<br />
<strong>City</strong> Town Province Postal Code<br />
Locust Hill ON LOH 1J0<br />
Peter<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
905 0476 201<br />
peter@yourvoicepickering ca<br />
Regional Councillor 3<br />
Name <strong>of</strong> Municipality<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 26 306 10<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1 18 798 22<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 15 947 07 j<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 593 25<br />
6 Total <strong>of</strong> all campaign expenses from Box C 16 540 32<br />
7 Election campaign surplus deficit from current election from Box E 257 90<br />
8 Contributions refunded to candidate or spouse from Box E 257 90<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 04 21 2010 12 31 Peter Rodrigues<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate 14 543 22<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 4255 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income 18 798 22 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 449 10<br />
Bank charges 285<br />
Brochures 3045 46<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee 100<br />
Office expenses 1902 81<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 10 446 85<br />
Other provide full details<br />
1<br />
Is<br />
2<br />
Is<br />
3 Is<br />
Is<br />
Subtotal Is 15 947 07 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting<br />
and audit 593 25<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
related to recounts<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Is 593 25 C3<br />
Total Campaign Period Expenses C2 C3 16 540 32 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is 257 90<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31 2010<br />
Assets<br />
Cash 3565 39<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from schedule 4 4339 30<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 7904 69<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 7904 69<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities 7904 69<br />
i BoxE Statement<strong>of</strong> Determination<strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong><br />
Surplus PartI Determination<strong>of</strong> Surplusor<br />
Deficit Amount<strong>of</strong> excess deficiency<strong>of</strong> income over expenses from Box C257 90<br />
E1 Deduct Any deficit carried forward bythe candidate from immediately preceding<br />
electionif the <strong>of</strong>fices are with respect to the same<br />
E2 Surplusor deficit for the campaign period E1<br />
E2 Deduct Any refund<strong>of</strong> contributions to the candidateor spouse onlyif there is a surplus Is257<br />
90 Total Determination<br />
Is<br />
E3 Part II Disposition <strong>of</strong><br />
Surplus If line E3 showsa surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who<br />
was responsible for the conduct <strong>of</strong> the<br />
election Surplus paid to the municipal clerk <strong>of</strong> the municipality<br />
jurisdiction<br />
<strong>of</strong> BoxF<br />
DeclarationI Peter Rodriguesacandidate inthe municipality<br />
<strong>of</strong> P C hereby declare that to the best <strong>of</strong>my knowledge and belief that<br />
these financial statements and attached supporting schedules are true and<br />
correct Declared before clerk or<br />
commissioner in<br />
the C f<br />
P C1 cr VN<br />
Aon yyyy mm dd pICU<br />
Sly<br />
IJ Signature<strong>of</strong> Clerkor Commissioner Signature<strong>of</strong><br />
Candidate aot<br />
0S Date Filed in the ClerksOffice yyyy mm<br />
dd 9503P 2010 01 Page 3 <strong>of</strong>
Schedule 1<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate 14 543 22<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or 2450 00<br />
spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
1805 00<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 18 798 22<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Lore Almack RR5 <strong>Pickering</strong><br />
Mema Burkholder RR2 Stn Main <strong>Pickering</strong><br />
Steve Manning<br />
2065 Blue Ridge Cres <strong>Pickering</strong><br />
Donna Manning<br />
2065 Blue Ridge Cres <strong>Pickering</strong><br />
ON L I Y IA2 500<br />
ON L IV 2P9 150 00<br />
ON L1 X 2N5 500<br />
ON L I X 2N5 500<br />
William P Wilder 40 King St W Toronto ON MSH 3Y2 500<br />
Robert Verbancic 283 Concession 3 <strong>Pickering</strong><br />
ON LI V 2P8 300<br />
Is<br />
Additional information is listed on separate supplementary attachment Total I 2450 00<br />
is<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
SGhedule 2 Fund Raising Function<br />
Date<br />
Additional schedule for each event or activity<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2B include in Schedule 1<br />
Part If Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8 IS<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3 Is<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
I<br />
I<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign Used in Candidate s Campaign<br />
I<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Printed signs<br />
24 a 16 2010 09 14 Print Me Design Inc 509 400 2036 00<br />
Printed signs<br />
32 x 48 2010 09 28 Print Me Design<br />
Inc 14 69 70 1028 30<br />
Printed Signs<br />
24 x 12 12 2010<br />
Print Me Design Inc 255 500 1275 00<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 4339 30<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8 i
i<br />
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
<strong>Pickering</strong> 2011 03 23<br />
Contact Person<br />
Licence No<br />
Last Name<br />
First Name<br />
Sinclair Neil 30<br />
Address<br />
Suite Unit No Street No Street Name<br />
4 144 Old Kingston Road<br />
<strong>City</strong> Town Province Postal Code<br />
Ajax ON LIT 2Z9<br />
Telephone No incl area code Fax No Email Address<br />
905 683 8856 ext 224 905 683<br />
3428 nsinclair@hsmca com<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
i<br />
INDEPENDENT AUDITORS REPORT<br />
Municipal Elections Act 1996 Section 78<br />
To Debbie Shields <strong>City</strong> Clerk<br />
We have audited the Statement <strong>of</strong> Assets and Liabilities as at December 31 2010 and the Statement <strong>of</strong><br />
Campaign Period Income and Expense and the Statement <strong>of</strong> Determination <strong>of</strong> Surplus<br />
Peter Rodrigues candidate for the campaign period from April 21 2010 to December 31 2010<br />
relating to the election held on October 25 2010<br />
or Deficit <strong>of</strong><br />
Candidate s Responsibility for the Financial Statements<br />
The candidate is responsible for the preparation and fair presentation<br />
accordance with the Municipal Elections Act 1996 Section 78<br />
<strong>of</strong> these financial statements in<br />
and for such internal controls as the<br />
candidate determines is necessary to enable the preparation <strong>of</strong> financial statements that are free from<br />
material misstatement whether due to fraud or error<br />
Auditors Responsibility<br />
Our responsibility is to express an opinion<br />
conducted our audit in accordance with Canadian generally accepted auditing<br />
standards require that we comply with ethical requirements and plan and perform<br />
on these financial statements based on our audit We<br />
standards Those<br />
the audit to obtain<br />
reasonable assurance about whether the financial statements are free from material misstatement<br />
An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in<br />
the financial statements The procedures selected depend on the auditors judgment including the<br />
assessment <strong>of</strong> risks <strong>of</strong> material misstatement <strong>of</strong> the financial statements whether due to fraud or error<br />
In making those risk assessments the auditor considers internal control relevant to the candidate s<br />
preparation and fair presentation <strong>of</strong> the financial statements in order to design audit procedures that are<br />
appropriate in the circumstances but not for the purposes <strong>of</strong> expressing an opinion<br />
on the effectiveness<br />
<strong>of</strong> the candidate s internal control An audit also includes evaluating the appropriateness <strong>of</strong> accounting<br />
policies used and the reasonableness <strong>of</strong> accounting estimates made by the candidate as well as<br />
evaluating the overall presentation <strong>of</strong> the financial statements<br />
We believe that the audit evidence we have obtained is sufficient and appropriate to provide<br />
our qualified audit opinion<br />
a basis for<br />
Basis For Qualified Audit Opinion<br />
Due to the nature <strong>of</strong> the types <strong>of</strong> transactions inherent in an election campaign it is impracticable<br />
through auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods<br />
GAfl4j f7al fGi2 cll Llr y TI1i<br />
aP e2ec cnnrn fcrae
and services and receipts and disbursements our<br />
Accordingly verification <strong>of</strong> these transactions was<br />
limited to ensuring that the financial statements reflect the amounts recorded in the accounting records<br />
<strong>of</strong> Colleen Jordan candidate in accordance with the accounting procedures established by the<br />
Municipal Elections Act 1996 and we were not able to determine whether any adjustments might be<br />
necessary to income and expenses assets or liabilities and surplus deficit<br />
Qualified Opinion<br />
In our opinion except for the possible effects described in the Basis for Qualified Opinion paragraph<br />
the financial statements present fairly in all material respects the financial position<br />
election campaign as at December 31 2010 and the income and expenses from the campaign period<br />
from April 21 2010 2010 to December 31 2010 and the determination <strong>of</strong> surplus<br />
or deficit and the<br />
disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
<strong>of</strong> the candidate s<br />
Basis <strong>of</strong> Accounting<br />
Without modifying our opinion<br />
prepared in accordance with The Municipal Elections Act 1996 to meet the requirements<br />
As a result the financial statements may not be suitable for another purpose<br />
we draw attention to the fact these financial statements have been<br />
<strong>of</strong> that Act<br />
HURREN SINCLAIR MACINTYRE CHARTERED ACCOUNTANTS<br />
March 23 2011<br />
Ajax Ontario<br />
CATl I7<br />
eGL h612y e7L47T<br />
LP tfeaed c7 rnru aJ
te<br />
r Ontario and Housing<br />
Ministry <strong>of</strong> Municipal Affairs<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 821<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Registrant Candidate<br />
Last Name<br />
First Name<br />
R0 7<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
7 15 c<br />
Middle Initial<br />
<strong>City</strong> Town Province Postal Code<br />
Locys7iL ON Lo j o<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
705 1 Zo qC6 o 0 5 Z01 o47<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the Ward<br />
question for which the registrant incurred expenses<br />
REG 0 At L CG YAl CI LL ag<br />
Name <strong>of</strong> Municipality<br />
plc Iv<br />
Declaration<br />
I<br />
PE7 6R Ro Z Q t GU E S<br />
name or no if any<br />
the candidate registrant mentioned above hereby give notice<br />
and declare to the clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
Declared before me<br />
at the<br />
<strong>of</strong><br />
in the<br />
t<br />
N<br />
Lk r<br />
<strong>of</strong><br />
this day <strong>of</strong> 20 L<br />
Signature <strong>of</strong> Clerk<br />
Signature<br />
aoio IX0 7<br />
Date yyyy mm dd<br />
<strong>of</strong> Candidate Registrant<br />
ablo lf07<br />
Date yyyy mm dd<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en frangais
s <strong>Report</strong><br />
Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><br />
appropriate Candidates who receive contributions or incur expenses<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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 05 to 2010 12 31<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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Ashe Kevin G<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
74 1701 Finch Avenue<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
<strong>Pickering</strong><br />
L1V OB7<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 426 0996 905 239<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
8101 Kashe@city<strong>of</strong>pickering com<br />
<strong>City</strong> councillor 1<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box 13 Surnmary<strong>of</strong> CampaignIncome and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk<br />
Is was 23 882 00<br />
2 Surplus or deficit from previous election Is 91100<br />
3 Total contributions received from Schedule 1 Is 25 050 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
Is 22 346 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 379 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
Is 725 00<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is 675 00<br />
8 Contributions refunded to candidate or spouse from Box E Is 00<br />
9 Amount paid to clerk from Box E<br />
I O<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box<br />
Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 05 2010 12 31 Kevin Ashe<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 25 050 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income Is 25 050 00<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 10 500<br />
Bank charges<br />
332 00<br />
Brochures 5287 00<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3 500<br />
Meetings hosted<br />
Nomination filing fee<br />
Office expenses 132 00<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 905 00<br />
Signs Is 1520 00<br />
Other provide full details<br />
842 00<br />
1 Delivery<br />
2 Date base charges<br />
734 00<br />
3 Promotion 594 00<br />
Subtotal 22 346 00<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 847 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation<br />
Expenses<br />
1<br />
2<br />
3<br />
notices 2532 00<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal C3<br />
379 00<br />
Total Campaign Period Expenses C2 C3 Is 25 725 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 Is 675 00<br />
9503P 2010101 Page 2 <strong>of</strong> 8
Box b Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 675 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 675 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
847 00<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities Is 847 00<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
00 E1<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 675<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E2<br />
91100 E2<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I K 2j Ash e a candidate in the municipality <strong>of</strong><br />
CI l<br />
p T P k c et 1<br />
9<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attached supporting schedules are true and correct<br />
E3<br />
Declared before clerk or commissioner<br />
in the<br />
1<br />
i LIE e r<br />
on yyyy mm dd o a l S<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
gn<br />
ture <strong>of</strong> Candidate<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 12<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schddule I<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse Is 25 050 00<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 25 050 00<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A 113<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
see attached list<br />
Additional information is listed on separate supplementary attachment Total 9 50<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Tabld 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
S<br />
Sid<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goodsor Services<br />
Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
a s 0 Page 5 <strong>of</strong> 8<br />
9503P 2010101
I<br />
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete<br />
breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2113 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
I 9503P 2010 01 Page 6 <strong>of</strong>
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
signs from prior 500<br />
campaign<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 500<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier<br />
Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign<br />
Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
02 09<br />
<strong>Pickering</strong> 2011<br />
Contact Person<br />
Last Name<br />
Rutland<br />
Address<br />
Suite Unit No Street No Street Name<br />
1024 Rouge Valley Drive<br />
First Name<br />
Edward<br />
Licence No<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> On L1 V 4N7<br />
Telephone No incl area code Fax No Email Address<br />
905 666 2720 ext 905 1042 666<br />
L u<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
AUDITOR S REPORT<br />
TO<br />
Kevin Ashe<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Kevin Ashe candidate for the campaign period <strong>of</strong> January S 2010 to December<br />
31 2010 for the election held on October 25 2010 These financial statements are the responsibility <strong>of</strong><br />
Kevin Ashe candidate Our responsibility is to express an opinion<br />
on these financial statements based<br />
our<br />
upon audit<br />
Except as explained in the we<br />
following paragraph conducted our audit in accordance with Canadian<br />
generally accepted auditing standards Those standards require that we plan and perform<br />
an audit to obtain<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
examining on a test basis evidence supporting<br />
the amounts and disclosures in the financial statement An<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation <strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from January 5 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit<br />
and the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario February 8 2011
2010 Campaign Contributions<br />
Name<br />
Address Amt Date Deposit Total<br />
002<br />
David Smuschkowitz<br />
21 Steele Valley Rd<br />
Thornhill UT 1M2 300 Jan 14 300<br />
003<br />
William Wilder<br />
Suite 4802 box 105<br />
40 King<br />
St West<br />
Toronto M5H 3Y2 500 Jan 18 800<br />
004<br />
Min Com New Choice Realty Ltd<br />
Att Garry Free<br />
65 67 Old Kingston Rd<br />
Ajax<br />
UT 3A5 250 Jan 29 1050<br />
005<br />
Metrus Development Inc 2<br />
30 Floral Parkway Suite 300<br />
Concord L4K 4R1 500 Feb 11 1550<br />
006<br />
Lorne Almack<br />
RR 5 Stn Main<br />
<strong>Pickering</strong><br />
11Y IA2 300 Feb 18 1850<br />
007<br />
Dutchmaster Nurseries Ltd<br />
3725 Sideline 16 North<br />
Brougham<br />
LOH lA0 250 Feb 23 2100<br />
008<br />
Invar Building Corporation<br />
220 Duncan Mill Rd<br />
Suite 301<br />
Toronto M3B 3J5 750 Feb 24 2850<br />
009<br />
Binns Inc
333 Kingston Rd<br />
<strong>Pickering</strong> L1V lAl 200 March 2 3050<br />
010<br />
Jack Winberg<br />
26 Breen Cres<br />
Willowdale M2P 1Z7 200 March 12 3250<br />
011<br />
Bitondo s Market Limited<br />
RR No 1<br />
Locust Hill LOH 1J0 350 March 18 3600<br />
012<br />
Edukids Child Care Centre Ltd<br />
1875 Glenanna Rd<br />
<strong>Pickering</strong> L1V 3V6 100 March 19<br />
2010 3700<br />
013<br />
Lorne Coe<br />
138 Tom Edwards Dr<br />
Whitby L1R 2S2 200 March 24 3900<br />
014<br />
Mattamy Development Corporation<br />
2360 Bristol Circle 400 June 4 2010 4300<br />
Oakville L6H 6M5<br />
015<br />
George Ashe<br />
2800 Courtice Rd 52<br />
Courtice 100 June 4 2010 4400<br />
016<br />
1061475 Ontario Limited 750 July 14 2010 5150<br />
Marshall Homes<br />
1295 Wharf Street 9<br />
<strong>Pickering</strong> L 1 W 1A2<br />
017<br />
Runneymede Development<br />
Corp Ltd 750 October 20 2010 5900<br />
1051 Tapscott Rd<br />
Toronto M 1 X 1 A 1
018<br />
Lebovic Enterprises Limited 500 July 26 2101 6400<br />
PO Box 1240<br />
Stouffville Ont L4A 8A2<br />
019<br />
Mosey Mosey Insurance Agency Ltd<br />
100 Milverton Ave 604 500 July26 2010 6900<br />
Mississauga L5R 4H1<br />
020<br />
Nicou Inc 150 July 26 2010 7050<br />
63 Johnson St<br />
Thornhill UT 2N9<br />
21<br />
SR<br />
R Bay Ridges Two LTD<br />
150 Ferrand Dr 801<br />
Toronto M3C 3E5 750 July 30 2010 7800<br />
022<br />
Picore Holdings Limited 500 August 9 2010 8300<br />
80 Queen Street<br />
Kingston<br />
K7K 6W7<br />
023<br />
Steve De Guise 750 August 9 2010 9050<br />
139 Indian Lake Rd<br />
RR 1<br />
Elgin<br />
Ontario KOG lE0<br />
024<br />
Michael Dawson 250 August 9 2010 9300<br />
PO Box 475<br />
Verona Ont KOH 2W0<br />
025<br />
Doumouras Properties Ltd 200 August 11 2010 9500<br />
PO Box 72040<br />
1562 Danforth Ave<br />
Toronto M4J 5C1<br />
026<br />
John Boddy Developments Ltd<br />
409 Kingston Rd West 200 August 18 2010 9700<br />
Ajax L1S 617
027<br />
Margo Ashe 200 August 25<br />
2800 Courtice Rd 52<br />
Courtice<br />
2010 9900<br />
028<br />
The Bench Press Ltd 250 September 2 2010 10150<br />
2402 Stouffville Rd<br />
PO Box 245<br />
Gormley ONT LOH I GO<br />
029<br />
Spar Ro<strong>of</strong>ing Supplies Ltd 750 July 2010 10900<br />
1360 Bloor St West<br />
Toronto M6H 1P2<br />
030<br />
Westhall Investments Ltd 750 September 9<br />
1815 Ironstone Manor<br />
<strong>Pickering</strong><br />
L1W 3W9<br />
2010 11650<br />
031<br />
Malone Given Parsons Ltd<br />
140 Renfrew Drive 250 September 10 2010 11900<br />
Markham L3 6B3<br />
001<br />
Grand Communities Inc 750 GOODS September 28<br />
4701 Steeles Ave W West Attria<br />
220 Toronto M9L 1X2<br />
2010 12650<br />
032<br />
Marant Construction Ltd 500 September 28 2010 13150<br />
200 Wicksteed Ave<br />
Toronto M4G 2B6<br />
033<br />
Don Mills Golf Centre Ltd 250 September 28 2010 13400<br />
PO Box 4080<br />
Markham Industrial Park PO<br />
Markham UR 9R8<br />
034<br />
Brennan Paving Construction Ltd<br />
PO Box 3459 Markham 250 September 28 2010 13650<br />
Markham UR 6G7
035<br />
The Sernas Group Inc 300 September 30 2010 13950<br />
110 Scotia Crt 41<br />
Whitby<br />
LIN 8Y7<br />
36<br />
Krzyszt<strong>of</strong> Trzcinski 750 October 5 2010 14700<br />
86 Mountainberry Rd<br />
Brampton<br />
L6R 2L7<br />
037<br />
Hiroslav Trzcinski 750 October 5 2010 15 450<br />
86 Mountainberry Rd<br />
Brampton L6R 2L7<br />
038<br />
Edward Jerzykiewicz<br />
1305 Wilson Ave 612 750 October 5 2010 16 200<br />
Downsview M3M 1J2<br />
039<br />
L Trzcinska 750 October 5 2010 16950<br />
1305 Wilson Ave 612<br />
Downsview M3M 1J2<br />
040<br />
Maylor Construction Ltd 750 October 6 2010 17700<br />
9488 McCowan Rd<br />
Markham UP 3J3<br />
041<br />
Louisville Homes Ltd 750 October 8 2010 18450<br />
11 Colonel Danforth Tr<br />
Toronto M 1 C 1 P 8<br />
042<br />
Bayfield Realty Advisors Inc 200 October 8 2010 18650<br />
904 2300 Yonge Street<br />
Toronto M4P 1E4<br />
043<br />
TACC Construction Ltd 500 October 11 2010 19150<br />
270 Chrislea Rd<br />
Woodbridge<br />
L4L 8A8
044<br />
Steven Ashe 100 October 13 2010 19250<br />
2800 Courtice Rd 52<br />
Courtice L 1 E 2M6<br />
045<br />
Alfin Financial Corp 500 October 13 2010 19750<br />
44 Upjohn Rd<br />
Toronto M3B 2W I<br />
47<br />
Todd McCarthy<br />
Flaherty Dow Elliot McCarthy<br />
120 Adelaide St West 2501<br />
Toronto M5H 1T1 750 October 15 2010 20 500<br />
046<br />
Durham Region Heavy<br />
co 1631 Bethesda Sideroad<br />
Contractors Association<br />
Richmond Hill L4E OG8 150 October 18 2010 20 650<br />
048<br />
John Macdonald 250 October 20 2010 20 900<br />
259 Cam Fella Blvd<br />
Stouffville L4A 7G3<br />
<strong>Pickering</strong> Square Inc 100 049<br />
Rougemount Square 100 050<br />
<strong>Pickering</strong> Square 1986 Inc 100 51<br />
1550 Kingston Rd 300 October 20 2010 21 200<br />
<strong>Pickering</strong> LIV 1 C3<br />
52<br />
Anna Gabrielle Kapinski<br />
co Aristocrat<br />
1895 Clements Rd 161<br />
<strong>Pickering</strong> L1W 3V5 750 October 22 2010 21 950<br />
53<br />
Guery Goyo 750 October 21 2010 22 700<br />
70 Kokanee Crt<br />
Maple<br />
Ont L6A 2V8<br />
54<br />
Purdue Frederick Inc 500 October 27 2010 23 200<br />
575 Granite Court
k<br />
i<br />
<strong>Pickering</strong><br />
L1W 3W8<br />
55<br />
Grant Morris Associates Ltd 350 November 4 2010 23 550<br />
397 Sheppard Ave<br />
<strong>Pickering</strong><br />
L IV 1 E6<br />
56<br />
2143087 Ontario Limited 750 November 23 2010 24 300<br />
207 2985 Drew Rd<br />
Mississauga<br />
L4T OA1<br />
57<br />
Ralph Del Duca 750 December 14 2010 25 050<br />
co Orion Realty Corp<br />
500 3550 Victoria Park Ave<br />
North York M2H 2M5
I<br />
I<br />
The Corporation <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
PICKERING<br />
<strong>Pickering</strong> Civic Complex<br />
One The Esplanade<br />
<strong>Pickering</strong> ON L1V 6K7<br />
1811 BICENTENNIAL 2011 city<strong>of</strong>pickering com<br />
Administration Department<br />
Legal Legislative Services Division Clerk s Office<br />
T 905 420 4611<br />
Toll Free1866 683 2760<br />
TTY 905 1739 420<br />
Fax 420 905 9685<br />
Email clerks@city<strong>of</strong>pickering com<br />
March 28 2011<br />
SENT VIA REGISTERED MAIL<br />
James Blair<br />
682 Foxwood Trail<br />
<strong>Pickering</strong> ON<br />
L1V 3X8<br />
Subject 2010 Municipal Elections Financial Statement<br />
FileA2000 001 11<br />
TAKE NOTICE that you are in default <strong>of</strong> the requirements <strong>of</strong> the Municipal Elections<br />
Act 1996 as amended because you failed to file documents namely your financial<br />
statement with the <strong>City</strong> Clerk as required by Section 78 <strong>of</strong> the Municipal Elections Act<br />
1996 as amended on or before200 pm on Friday March 25 2011<br />
As a result you are now ineligible to be elected or appointed to any<br />
Municipal Elections Act 1996 as amended applies until the next regular<br />
taken place<br />
in 2014<br />
<strong>of</strong>fice to which the<br />
election has<br />
If you have any question regarding this matter please feel free to contact me directly at<br />
905 420 4660 ext 2019<br />
Yours truly<br />
Debbie Shields<br />
<strong>City</strong> Clerk<br />
DS kn
Ontario<br />
Mnistry<strong>of</strong>Municipal<br />
Affairs<br />
Financial<br />
and Housing<br />
Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DID<br />
For the campaign period from day candidate filed nomination 1a010<br />
0<br />
3Q<br />
to L<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle In<br />
jlL<br />
Am eS<br />
Mailing Address<br />
Suite Unit No Street No Street<br />
Z Namox<br />
<strong>City</strong> To<br />
Provinc<br />
Postal Code<br />
Telephone No incl area code Fax No Em I Address<br />
Business<br />
Home<br />
yos yyz ZZZ<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought elec ion Ward Name or N if any<br />
t 0 C c 0 1<br />
Name <strong>of</strong> Munici<br />
y<br />
G 1<br />
Box B Summary <strong>of</strong> Campaign Inc<br />
a and Expenses<br />
1 My spending limit as issued by clerk was 3 g Z<br />
2 Surplus or deficit from previous election Fs<br />
3 Total contributions received from Schedule 1 Is 7 Q 3<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
6 Total <strong>of</strong> all campaign expenses from Box C Z<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
@ Queen s Printer for Ontario 2010 Disponible en franpis Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
0201 0 o1i<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part 111<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign<br />
Period Income<br />
C1<br />
X03<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
G<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee 00<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other pro<br />
full details<br />
O<br />
O<br />
2<br />
3<br />
Subtotal<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part Iv<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
appreciation notices<br />
related to candidate s disability provide details<br />
C2<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2<br />
C3<br />
C3<br />
C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 Page 2 <strong>of</strong> 8<br />
9503P 2010
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities F7 1<br />
BoxEStatement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus<br />
or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
Part If<br />
Disposition <strong>of</strong> Surplus<br />
E2<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
a candidate in the municipality <strong>of</strong><br />
R n o G g Uq hereby declare that to the best <strong>of</strong> my knowledge<br />
financial statements and att ched supporting schedules ague and correct<br />
and belief that these<br />
E1<br />
E2<br />
E3<br />
Declared before clerk or commissioner<br />
inthe<br />
1 cV Ct v<br />
on<br />
yyyy mm dd QG L L G l E S<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
ao t t lC3 2S S5<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
r<br />
Signature <strong>of</strong> Candidate<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER 25 MAR li 352fti<br />
PURSUANT TO SECTION 1121<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
f<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling<br />
more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Less<br />
Contribution returned or<br />
payable to the contributor<br />
Contribution paid or payable<br />
to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business Manager<br />
Business As<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
WC<br />
vz<br />
7 14 01<br />
lrv C rltl<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
I<br />
Additional schedule for each event or activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2121 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 7 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description<br />
Date Acquired Supplier<br />
Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
Province<br />
Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
IbLLP AURORA<br />
K A R K H E C K<br />
B L O O M B E R G<br />
K A R K H E C K<br />
BLOOMBERG<br />
LLP<br />
C H A R T E R E D<br />
ACCOUNTANTS<br />
13 CHURCH STREET<br />
ONT L4G 1G5<br />
T905 727 0400<br />
F905 727 0482<br />
Auditor s <strong>Report</strong><br />
Campaign to Elect Sherry Croteau<br />
We have audited the Financial Statement Auditor s <strong>Report</strong> Form 4 as at December 31<br />
2010 These financial statements are the responsibility <strong>of</strong> Sherry Croteau Our<br />
responsibility is to express an opinion<br />
We<br />
on the financial statement based on our audit<br />
conducted our audit in accordance with Canadian<br />
generally accepted auditing<br />
standards require that we plan and an<br />
perform audit to obtain<br />
standards Those<br />
reasonable assurance whether the financial statements are free <strong>of</strong> material misstatement<br />
An audit includes examining on a test basis evidence supporting<br />
disclosures in the financial statement<br />
the amounts and<br />
In our<br />
opinion the financial statement present fairly in all material respects the financial<br />
position <strong>of</strong> the Campaign as at December 31 2010 and the summary <strong>of</strong> campaign income<br />
and expenses for the period then ended in accordance with Canadian generally accepted<br />
accounting principles<br />
3ccP ie<br />
Xba m PB<br />
Authorized to practice public accounting by<br />
The Institute <strong>of</strong> Chartered Accountants <strong>of</strong> Ontario<br />
Chartered Accountants<br />
February 23 2011<br />
1
I<br />
Lr Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 05 to 2010 12 31<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Croteau Sherry L<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
275 Stover Cres<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1V 6R1<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 831 4617 sherrycroteau@yahoo com<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
<strong>City</strong> Council Ward 1<br />
Name <strong>of</strong> Municipality<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 23 882 75<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1<br />
Is 11 752 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 11 386 15<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is<br />
6 Total <strong>of</strong> all campaign expenses from Box C 11 386 15<br />
7 Election campaign surplus deficit from current election from Box E 365 85<br />
8 Contributions refunded to candidate or spouse from Box E<br />
I 365 85<br />
9 Amount paid to clerk from Box E<br />
Is<br />
00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 05 2010 12 31 Sherry Croteau<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 7000<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions 4752 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 00<br />
Interest income 00<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income Is 11 752 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 3797 63<br />
Bank charges 72 70<br />
Brochures 2389 95<br />
Interest on loan 00<br />
Inventory<br />
contributed to candidate s campaign Schedule 3 870 00<br />
Meetings hosted 00<br />
Nomination filing fee 100<br />
Office expenses 33 06<br />
Phone and or Internet 00<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 00<br />
Signs 3529 56<br />
Other provide full details<br />
1 Printing 593 25<br />
2<br />
3<br />
Subtotal 11 386 15 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV 00<br />
Expenses related to compliance audit 00<br />
Expenses related to controverted elections 00<br />
Expenses<br />
related to recounts 00<br />
Voting day parry appreciation notices 00<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C3<br />
Total Campaign Period Expenses C2 C3 Is 11 386 15 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is 365 85<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
BOX D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 1641 99<br />
Accounts receivable 00<br />
Value <strong>of</strong> inventory retained from Schedule 4 2543 50<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Is 4185 49<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 00<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement<strong>of</strong> Determination<strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 365 85 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 365 85<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus 365 85<br />
Is<br />
00 E2<br />
Total Determination<br />
Is 00 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong> 00<br />
Box F Declaration<br />
Sherry Croteau<br />
a candidate in the municipality <strong>of</strong><br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in<br />
i<br />
the<br />
Ck O PGl eriG<br />
on yyyy mm dd ao l l 0 Q<br />
L<br />
Signature <strong>of</strong> Clerk or Commissioner i nature <strong>of</strong> Candidate<br />
Pik 1C3CSI<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE MSHI EWS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 12<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 7000<br />
Contribution from spouse 00<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or<br />
spouse 4552 00<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse 200<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable<br />
to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 11 752 00<br />
Total contribution from anonymous sources<br />
1B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 113<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Steve DeGuise 139 Indian Lake Road RR1 Elgin<br />
ON 750 00<br />
Andrew Beacom 29 Creekwood Cres Whitby ON 200<br />
Warren Ingrid Beacom 17 Brigadier Pl Toronto ON<br />
652 00<br />
Hedi Walter Hoch 69 Wanita Dr Toronto ON 750 00<br />
Jack Siegal 2 Queen St E Ste 1500 Toronto ON 100<br />
Additional information is listed on separate supplementary attachment Total 2452 00<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Picore Holdings Ltd 80 Queen St Kingston ON 750 00<br />
Priority Submetering<br />
1465 <strong>Pickering</strong> Parkway Ste 100 A Beacom A Beacom<br />
<strong>Pickering</strong> ON 700<br />
Additional information is listed on separate supplementary attachment Total 1450 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Ashlyn King 79 Chalmers Cres Ajax ON Photos 100<br />
Nadia Morel 832 Thornton Rd N Oshawa Website development<br />
ON<br />
750 00<br />
Additional information is listed on separate supplementary attachment Total 850 00<br />
Total Part 11 Contributions 4752 00<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
No events<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
26<br />
Part I Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Is<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
i<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Rebar<br />
2006 03 01 Boss Steel 300 100 300<br />
Corplast<br />
Corplast<br />
01 2006 09<br />
10 00 30 300<br />
2003 09 01 10 00 27 270 00<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 870 00<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
y ymm dd<br />
Rebar<br />
2006 03 01 Boss Steel 300 80 240 00<br />
Large Signs<br />
2010 09<br />
Sankets Can 32 30 40 1292 00<br />
Maximum Signs<br />
Small Signs 2010 09<br />
Media Works 289 350 1011 50<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 2543 50<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s<strong>Report</strong><br />
Municipal Bections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
CA<br />
Municipality<br />
Aurora<br />
Contact Person<br />
Last Name<br />
Karkheck<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
13 Church Street<br />
First Name<br />
Jeremy<br />
Dateyyyy mm dd<br />
Province<br />
Licence No<br />
Postal Code<br />
Aurora ON L4G I G5<br />
Telephone No incl area code Fax No Email Address<br />
905 727 0400 ext 225 905 727<br />
0482 jarkheck@jskcapc ca<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
te<br />
Ontario and Housing<br />
Ministry <strong>of</strong> Municipal Affairs Notice <strong>of</strong> Extension <strong>of</strong> Cam pai 9 n<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 821<br />
Instructions<br />
1 1 rat S 2 K o<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Candidate Registrant<br />
Last Name First Name Middle Initial<br />
rot at<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
S<br />
<strong>City</strong> Town Province Postal Code<br />
F1 ckp rj<br />
V t l<br />
Telephone No incl a a code Fax No Email Address<br />
Business<br />
l Home 3S 5kev Goac Gvv<br />
r<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the Ward<br />
question for which the registrant incurred expenses<br />
lVllV<br />
Name <strong>of</strong> Municipality<br />
S <strong>of</strong><br />
Declaration<br />
I<br />
Set r n<br />
C1<br />
name or no if any<br />
VGtY<br />
the candidate registrant mentioned above hereby give notice<br />
and declare to the clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
Declared before me<br />
at the<br />
<strong>of</strong><br />
1 l C K C C vt c<br />
in the<br />
<strong>of</strong><br />
this tom day <strong>of</strong> 20 1 U<br />
C<br />
ILI<br />
Signature <strong>of</strong> Clerk Sign re <strong>of</strong> Candidate Registrant<br />
QCIC<br />
Date yyyy mm dd<br />
<strong>of</strong>o 1a o<br />
Date yyyy mm dd<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en franpis
I<br />
March 29 2011<br />
Debbie Shields<br />
<strong>City</strong> Clerk<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
<strong>Pickering</strong> Civic Complex<br />
One The Esplanade<br />
<strong>Pickering</strong> Ontario<br />
L1V 6K7<br />
Dear Ms Shields<br />
Re Closing <strong>of</strong> Campaign Period<br />
Please be advised that the Campaign to Elect Sherry Croteau for the position <strong>of</strong><br />
Ward 1<br />
<strong>City</strong> Councillor is closed effective immediately<br />
A Financial Statement Form 4 supplemental filing<br />
that there were no financial activities in the campaign during the period from<br />
December 31 2010 to March 29 2011<br />
is attached The form reflects<br />
If there are any questions or concerns please do not hesitate to contact me at<br />
905 831 4617 or byemail at sherrycroteau ayahoo com<br />
Sincerely<br />
Sherry L<br />
Croteau<br />
275 Stover Crescent<br />
<strong>Pickering</strong> ON<br />
L1V 6R1<br />
Encl
s <strong>Report</strong><br />
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong> 10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2011 O1 01 to 2011 03 29<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Croteau Sherry L<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
275 Stover Crescent<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L1 V6R<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
905 4617 831<br />
sherrycroteau@yahoo com<br />
<strong>City</strong> Council Ward 1<br />
Name <strong>of</strong> Municipality<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 23 882 75<br />
2 Surplus or deficit from previous election 00<br />
3 Total contributions received from Schedule 1<br />
Is<br />
00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
001<br />
6 Total <strong>of</strong> all campaign expenses from Box C 00<br />
7 Election campaign surplus deficit from current election from Box E 00<br />
8 Contributions refunded to candidate or spouse from Box E 00<br />
9 Amount paid to clerk from Box E 00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2011 01 01 2011 03 29 Sherry L Croteau<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 00<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 00<br />
Interest income 00<br />
Other provide full details<br />
1 00 00<br />
2 0 00<br />
3 0 00<br />
Total Campaign Period Income<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 00<br />
Bank charges 00<br />
Brochures 00<br />
Interest on loan 00<br />
Inventory<br />
contributed to candidate s campaign Schedule 3 00<br />
Meetings hosted 00<br />
Nomination filing fee 00<br />
Office expenses 00<br />
Phone and or Internet 00<br />
Salaries and benefits honoraria<br />
pr<strong>of</strong>essional fees 00<br />
Signs 00<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV 00<br />
Expenses related to compliance audit 00<br />
Expenses related to controverted elections 00<br />
Expenses related to recounts 00<br />
Voting day party appreciation notices 00<br />
Expenses related to candidate s disability provide details<br />
1<br />
C2<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C3<br />
Total Campaign Period Expenses C2 C3 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 00<br />
Accounts receivable 00<br />
Value <strong>of</strong> inventory retained from Schedule a 00<br />
Other provide full details<br />
1 00<br />
2 0 00<br />
3 00<br />
Total Assets<br />
Is<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 00<br />
Borrowings overdraft 00<br />
Other provide full details<br />
1 00<br />
2 0 00<br />
3 00<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
00 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same<br />
jurisdiction<br />
00 E2<br />
Surplus or deficit for the campaign period E1 E2 00<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus 00<br />
Total Determination<br />
00 E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong> 0<br />
Box F Declaration<br />
1 VIA U a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attached supp<br />
ing schedules are true and correct<br />
Declared before clerk or commissioner<br />
i<br />
in the<br />
Ail O ti K tr y1<br />
on yyyy mm dd a l o 3<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
gnature<br />
<strong>of</strong> Candidate<br />
0rLo<br />
1 1 121<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 112<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 00<br />
Contribution from spouse<br />
00<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate 00<br />
or spouse<br />
Is<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse Is<br />
00<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor 00<br />
Contribution paid or payable to the clerk<br />
00<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
00 I B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 113<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment Total 00<br />
Total Part II Contributions 00<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or<br />
activity<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I Ticket Revenue<br />
Lines 2A x 26 include<br />
in Schedule 1<br />
Is<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Is<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
i<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Dateyyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ontario and Housing<br />
Ministry <strong>of</strong><br />
Municipal Affairs<br />
Financial Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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<br />
responsible<br />
for the conduct <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination I<br />
00 03 144 to<br />
I 120 0I 2 I 31<br />
Jfrimary filing reflecting finances to December 31 or 45 day after voting day in a by election<br />
Box A<br />
Supplementary filing including finances after December 31 or 45h day after voting day in a by election<br />
Name bf Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name<br />
M ailing Address<br />
Suite Unit No Street No Street Name<br />
X66<br />
First<br />
Ed czoato<br />
ACV<br />
Middle Initial<br />
<strong>City</strong> Town Province Postal Code<br />
000<br />
614 1Z1A14C ON 411V2 9<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
61102 J 01G C r<br />
Name <strong>of</strong> r<br />
Municipality<br />
Ward Name or No if any<br />
Box B Summary jot Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1<br />
Is 2 000<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 69 32<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
Is<br />
p<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E<br />
Is<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C tatemert <strong>of</strong> Campaign Period Income acid Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
02o l0 03 6 201 0 Z 3 t e46ell G4 1<br />
INCOME<br />
Candidate surplus from immediately preceding election released by the clerk<br />
Contributions from candidate p s 32<br />
Contributions from spouse <strong>of</strong> candidate<br />
5x 3<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
Is qs S2 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
2 93 SIP<br />
Bank charges to 3 60<br />
Brochures<br />
Sto 26<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
Nomination filing fee<br />
Office expenses<br />
contributed to candidate s campaign Schedule 3<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1 V aiZHZ S taiSt<br />
Nq<br />
M A<br />
A IQ<br />
Do<br />
3g gS<br />
S25 O<br />
25 O<br />
2 G3 try S r i2 0s0<br />
3 j3 u a C c2As CWPazAzIi stias MRFrr rs l E 21<br />
Subtotal 32 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit iv If 4<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2 C3 Is a q S 32 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1<br />
C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8<br />
C3
Box D Statement <strong>of</strong> Assets and Liabilttte as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4 5<br />
Other provide full details<br />
p<br />
1<br />
2<br />
3<br />
Total Assets<br />
57 ss<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
2<br />
3<br />
Total Liabilities<br />
Baxf Statement <strong>of</strong> Determination <strong>of</strong>Surpf usor Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E1<br />
E2<br />
E3<br />
Part It<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F<br />
De clarart ion<br />
I Co IS<br />
a candidate in the municipality <strong>of</strong><br />
Pt C AC hereby declare that to the best <strong>of</strong> 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 mm dd Ott 1 03 t I G<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature<br />
<strong>of</strong> Candidate<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS<br />
CITY OF CITY CLERK<br />
PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION<br />
OF THE 12<br />
COMMISSIONERS<br />
TAKING FOR<br />
AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1 Contributions<br />
Part 1 Contribution<br />
Contribution from candidate 3 2<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources 18<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 1B I<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
f2o J COA TE 7 EL1G tzroat4 t ON LIJ Z27 ZOO o0<br />
Nrt 1 AA CC I<br />
710 tg o Oct Pck OV LIJG13 If 750<br />
A tc Sat r4A tW trLIe O cTt4j 6O c o t oc At k gal P t c iL iI w t bS 50<br />
s 23ov you eS TOr OV IM4e I IK<br />
I Ftco Rc c AOVtQI<br />
DU rPO R ltev CIMItx kW 6 C 0 3c ll<br />
Tt DpScm lam PFc o 1 p<br />
W<br />
2p 0 CV<br />
Additional information is listed on separate supplementary attachment Total 21 000<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
b y o cCs DA<br />
wnr2 c At sQ<br />
Sz 2a1 2 i rc<br />
23 0<br />
yv cTs t WY<br />
QC 2r Dvi sa j vn AA 14 t rs4<br />
tieRcsc o or g A W i 200<br />
tA41Aist<br />
7rv l 01G Lt Sbztc<br />
RAAriCT we fi t ST vscsSL rWrr C ATreLL<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
U O<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
p<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2 Fund Raising Function<br />
Q Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admissioncharge per person may not exceed individual contribution lirnit<br />
if admission charge person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
2A<br />
Number <strong>of</strong> tickets sold 28<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part 11<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full details eg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part 111 Revenue include in Box C Is<br />
Part IV<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Expenses Related to Fund Raising Function<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Cam paign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
y mm dd<br />
StAls Zyx2q to<br />
j3w<br />
36126Pitics 5 s 2914<br />
36 x to<br />
cl<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 5<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections A6t 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation<br />
<strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ontario and Housing<br />
Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor s Re p<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
ort<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 03 15 to 2610 12<br />
131<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
NOLASC<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
LEONA RD<br />
9r S urnm EP PARS C1QtS UWT<br />
<strong>City</strong> Town Province Postal Code<br />
PiCAEWKG 6K M1R10 LiV 7132<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Name <strong>of</strong> Municipality<br />
qoS T q323 It JQn1 alasco 9 vrla icom<br />
Clfi GOUtJC1 L ONE<br />
Ci n OF PICKEn 1 NG<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was<br />
Is z o 1 6 rj<br />
2 Surplus or deficit from previous election Is<br />
N A<br />
3 Total contributions received from Schedule 1<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 3jq 6z<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C t4A<br />
6 Total <strong>of</strong> all campaign expenses from Box C 3 6q ap2<br />
7 Election campaign surplus deficit from current election from Box E 6<br />
8 Contributions refunded to candidate or spouse from Box E<br />
Is<br />
D<br />
9 Amount paid to clerk from Box E 0<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 02 15 1200 12 31 IE 6NgQp OL ASC 6<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk p<br />
Contributions from candidate o CA 6L<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1 91A<br />
2 W JA<br />
3 NlA<br />
Total Campaign Period Income 3001 02 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 6<br />
Bank charges<br />
Brochures<br />
Interest on loan 0<br />
Inventory<br />
contributed to candidate s campaign Schedule 3 0<br />
Meetings hosted 0<br />
Nomination filing fee 100<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 0<br />
Other provide full details<br />
1 wF srE QoM<br />
GOti tN Dp cora<br />
2 CANbtL DpS tF01a NAf10U SGS t01J<br />
3<br />
N<br />
O<br />
Q<br />
O<br />
O<br />
b<br />
O<br />
S<br />
z5z<br />
ISO dO<br />
Subtotal 3bI OZ C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 0<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
appreciation notices<br />
related to candidate s disability provide details<br />
1 NIA<br />
2 W IA<br />
3 N1<br />
Other provide full details<br />
1 pPt<br />
2 t ll<br />
3<br />
Subtotal O C3<br />
Total Campaign Period Expenses C2 C3 IS fDq 02 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4<br />
O<br />
WIA<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 0<br />
Accounts receivable 0<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
O<br />
Other provide full details<br />
1 O<br />
2 C<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
N1<br />
2<br />
3 iJ ip<br />
Total Liabilities I 0<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
PartIDetermination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C Q<br />
E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
0 E2<br />
Surplus or deficit for the campaign period E1 E2 j<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus 0<br />
Total Determination 0<br />
E3<br />
Part If Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong> fJ<br />
Box F Declaration<br />
I JEOMARO tb MASCO<br />
a candidate in the municipality <strong>of</strong><br />
Ti t Ct f Orr PtCVLRtka hereby declare that to the best <strong>of</strong> 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 />
Ci O<br />
on yyyy mm dd<br />
a<br />
Signature <strong>of</strong> Clerk or Commissioner Signature o ndidate<br />
aC iul Ial<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1 Contributions<br />
Part I Contribution<br />
Contribution from candidate<br />
6q Oz<br />
Contribution from spouse<br />
Total from each single contributor totalling<br />
more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Is D<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor 0<br />
Contribution paid or payable to the clerk 0 1A<br />
Total Amount <strong>of</strong> Contribution<br />
Is<br />
IA<br />
3f0QOZ<br />
Total contribution from anonymous sources O 1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 1 B 0<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
NIA N1a NIA<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Ttible 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
jI q1 A fJ1A<br />
Additional information is listed on separate supplementary attachment Total<br />
AIIA<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
j<br />
f<br />
Additional information is listed on separate supplementary attachment Total Q<br />
Total Part If Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
rJ A<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold 26<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 26 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory<strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
1<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
J lt<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
i<br />
I<br />
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ontario Ministry <strong>of</strong> inancial<br />
Municipal<br />
Affair4anle<br />
and Housing<br />
Statement Auditor s <strong>Report</strong><br />
orm 4<br />
unicipal Elections Act 9996 Section 78<br />
WO C 10 n<br />
Instructions 1Gw nC0r Fi 1 nq a a 5<br />
All candidates must complete Boxes A B C D E and F A I candidates must co glplete Scheddles 3 and 4 as Q<br />
appropriate Candidates who receive contributions orinexcess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong> Ifl 1Y10 t<br />
All surplus funds after any refund to the candidate orhishall be paid immediately over to the clerk who was responsible<br />
for the conduct <strong>of</strong> the election<br />
YYYY MM D YYYY MM DD<br />
For the campaign period from day candidate filed nomination Zal 6<br />
to oc0l 0<br />
Primary filing reflecting finances to December 31 or 45h day after voting day in a by election<br />
Supplementaryfiling including finances after December 31 or 45h day after voting day in a by election<br />
Box A Name <strong>of</strong>Gandi a4eand 0ffice<br />
Name <strong>of</strong> Candida<br />
Last Name Kln First Name Middle Initial<br />
Mailing Address<br />
Suite Unit No Street N Street ame<br />
Prov<br />
<strong>City</strong> Town<br />
5<br />
tJ<br />
t CsC<br />
Telephone No incl area code<br />
Business<br />
Home<br />
Pstal<br />
od<br />
Fax No Email Address<br />
1<br />
Name <strong>of</strong> <strong>of</strong>fice for w chi the andidate so ht electio Ward Name or No if any<br />
C<br />
YJ<br />
Name <strong>of</strong> Municipality<br />
iuc JZ<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was l D I<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
All<br />
My total campaign expenses that were not subject to the spending limit were from Box C<br />
6 Total <strong>of</strong> all campaign expenses from Box C 3 6I 1<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Q Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
uvn v vaaacnrcua yr vanrNaryrr rcrrvu nwvnrc<br />
atrunNcnaca<br />
From To For Candidate<br />
YYYY MM DD<br />
YYYL m L<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Z<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
C1<br />
EXPENSES Note iAclude the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subjectto Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee<br />
Q<br />
X<br />
Office expenses<br />
Phone and or Internet<br />
Salaries and benefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 222 t U<br />
Other provide full details<br />
2<br />
Subtotal<br />
TEd<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong> fund raising function from Schedule 2 Part IV<br />
C2<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
2<br />
3<br />
Subtotal<br />
3<br />
Total<br />
Campaign Period Expenses C2 C3 C4<br />
Excess Deficiency<strong>of</strong> lncome over Expenses C1<br />
C4<br />
9503P 2010<br />
Pae 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Is<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Is<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
E1<br />
E2<br />
Surplus or deficit for the campaign period E1<br />
E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination Is<br />
E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I 3p IP r z b a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attached supporti<br />
schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the<br />
on yyyy mm dd a2 I l Q q<br />
Signature <strong>of</strong> Clerk or<br />
o2D 1 Qq J<br />
Com miiss ioner<br />
Si atu o a at<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 12<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT
VVIIV J MIV 1 VVII IINMIVIIJ<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is100 or less<br />
include all goods and services where value is 100 or less<br />
Is<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A f 1B<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contribute<br />
ns from individuals other than candidate or spouse<br />
Name Address Amount<br />
A0 34<br />
eAJtt<br />
0<br />
77<br />
M t1s v<br />
o 13 iUt<br />
16<br />
At<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010101 Page 4 <strong>of</strong> 8
Name regal and Carrying on Address President or Cheque Signatory<br />
Amount<br />
Business Manager<br />
Business As<br />
YI<br />
u L t 1<br />
9<br />
1<br />
q uo 144thU<br />
Ii V<br />
1 cavk<br />
Q<br />
Additional information is listed on separate supplementary attachment Total 16<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Additional schedule for each event or activity held is are listed on<br />
separate supplementary attachment s<br />
Date<br />
YYYY<br />
MM<br />
DID<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold 28<br />
Pan I<br />
Ticket Revenue<br />
Lines 2A x 28 include in Schedule 1<br />
Part If Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
I<br />
Used in Candidate s Campaign<br />
Description<br />
Date Acquired Supplier<br />
YYYmm dd<br />
Unit Value Quantity Total Value<br />
Total Value <strong>of</strong> Inventory<br />
from Previous Campaign Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010101<br />
Page 7 <strong>of</strong> 8
I<br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an<br />
auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
Ontario and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
For the campaign period from day candidate filed nomination 03<br />
YYYY MM D YYYY<br />
01t 161 1<br />
to<br />
7010<br />
F1 Primary filing reflecting finances to December 31 or 45h 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 />
MM DD<br />
y<br />
1<br />
13 I<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidat<br />
Last Name<br />
Lo<br />
Mailing Address<br />
Suite Unit No Street N Street ame<br />
First Name<br />
Middle Initial<br />
<strong>City</strong> Town<br />
t<br />
n<br />
ProvSeJ<br />
Telephone No incl area code Fax No Email Address<br />
Business Home W6J<br />
Postal<br />
l<br />
od<br />
Name <strong>of</strong> <strong>of</strong>fice for wjy ch the<br />
andidate sought electiorl<br />
Ward Name or No if any<br />
Name <strong>of</strong> Municipality<br />
i uc cr Z<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1 Z<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is<br />
6 Total <strong>of</strong> all campaign expenses from Box C 3611 1<br />
7 Election campaign surplus deficit from current election from Box E<br />
is<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en franpais Page 1 <strong>of</strong> 8
BOX C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
zz<br />
From To For Candidate<br />
YYtL MM L6<br />
INCOME<br />
YYYY MM DD<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
fit j<br />
J<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
Z<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Q<br />
X<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee<br />
Office expenses<br />
l<br />
Phone and or Internet<br />
Salaries and benefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs Z U<br />
Other provide full details<br />
2<br />
3<br />
Subtotal<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
C2<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
s disability provide details<br />
related to candidate<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 3<br />
Total Campaign Period Expenses C2 C3 7 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4<br />
0<br />
9503P 2010<br />
Pa e 2 <strong>of</strong> 8
Box D Statement<strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
BoE Stateinerit <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E2<br />
E1<br />
E2<br />
E3<br />
Part 11<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaratio<br />
II<br />
Al<br />
l vU a candidate in the municipality <strong>of</strong><br />
l<br />
financial s atements and attached supporting schedules are true and correct<br />
clerk who was<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
C C 1r i V<br />
on<br />
yyyy mm dd 20 L 1<br />
Signature <strong>of</strong> Clerk or Commissioner Sign<br />
tun andidate<br />
aa fc 3 5 Date<br />
Filed in the ClerksOffice yyyymm dd DEBBIE<br />
M SHIELDS CITY CLERK CITY<br />
OF PICKERINGEX<br />
OFFICIO COMMISSIONER PURSUANT<br />
TO SECTION1 2OF<br />
THE COMMISSIONERSFOR TAKING<br />
AFFIDAVITS ACT 9503P<br />
201001 Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
r 01<br />
Wh n313<br />
6<br />
4UM L UV<br />
t04r j b MJ LrIJ v4n co<br />
C o 0cuc uljr t<br />
1 L tct su<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
t 9<br />
6<br />
Lw<br />
v<br />
Uj r5 RY4 714 11<br />
Uv I<br />
P<br />
Z<br />
Additional information is listed on separate supplementary attachment Total<br />
6<br />
W<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010101 Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution liMit Is 2A<br />
If admission charge person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Sphedule 3 7 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used iri Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4<br />
Inventory <strong>of</strong> Campaign Goods arid Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
y mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign<br />
Goods and Materials<br />
9503P 2010101 Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No<br />
Email Address<br />
ext<br />
9503P 2010101 Page 8 <strong>of</strong> 8
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 821<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Registrant Candidate<br />
Last Name First Nam Middle Ini al<br />
Mailing Address<br />
Suite Unit No Street Stre ame 1n<br />
<strong>City</strong> Town<br />
1j<br />
Telephone<br />
o incl area code Fax No Email Address<br />
Business<br />
Hom<br />
Province P9stal Co e<br />
6Ili<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidates ught election or the Ward<br />
question for which the registrant incurred expenses<br />
C C6 Gu<br />
Name <strong>of</strong> Mu<br />
cipality<br />
name or no if any<br />
Declaration fis the candidate registrant mentioned above hereby give notice<br />
and decl a tot clerk that I have a deficit and wish the campaign period to be extended in accordance with section 68<br />
Declared before me<br />
at the<br />
C rt<br />
<strong>of</strong><br />
Q C 1<br />
in the <strong>of</strong> V fna rY<br />
this day <strong>of</strong> Qom eavl r 20 1 Q<br />
Signature <strong>of</strong> Clerk ignature o a<br />
aoIri a I l<br />
Dateyyy mm dd de 16<br />
yyyr mm dd<br />
egistrant<br />
10550P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en frangais
te<br />
Ministry <strong>of</strong> Municipal Affairs<br />
Ontario and Housing<br />
Financial Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 12010<br />
07 21 to<br />
l<br />
2010 12<br />
I<br />
31<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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Atkinson<br />
I<br />
Garth J<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1025 Rouge Valley Dr<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
<strong>Pickering</strong> ON L 1 V l A 1<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 509 3511 509 905 2548 905 509<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
<strong>City</strong> Councillor 2<br />
Name <strong>of</strong> Municipality<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
0735 garthatkinson@rogers com<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 5 v<br />
2 Surplus or deficit from previous election<br />
Is<br />
00<br />
3 Total contributions received from Schedule 1 150 0<br />
4 My total campaign expenses that were subject to the spending limit were from Box C Is 3682 60<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is<br />
00<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
Is 3682 60<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E<br />
Is<br />
Is<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
@ Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 07 21 2010 12 31 Garth Atkinson<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 00<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions<br />
150 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 00<br />
Interest income 00<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income 150 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 1219 27<br />
Bank charges 27 60<br />
Brochures 410 89<br />
Interest on loan 33 92<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 1813 65<br />
Other provide full details<br />
Subtotal<br />
1 Postage 86 31<br />
2 Debate fee 65 00<br />
3 Office supplies 25 96<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
3682 60 C2<br />
Total Campaign Period Expenses C2 C3 Is 3682 60 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is 2532 60<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8<br />
C3
Borl Statement <strong>of</strong> Assets and Liabilities as at 31 Dec 2010<br />
Assets<br />
Cash 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4 400<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 400<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft 2532 60<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities 2532 60<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 2532 60 Ell<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 2532 60<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination Is 2532 60 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the fi ci statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
E2<br />
Box F Declaration<br />
I Garth Atkinson<br />
<strong>Pickering</strong><br />
financial statements and attached supporting<br />
schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
C 3v icy<br />
on yyyy mm dd<br />
OC cBG J<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature<br />
aott 1031 IS<br />
Date Filed in th Clerk s Office yyyy mm dd<br />
<strong>of</strong> Candidate<br />
USA DIANNE HARKER<br />
a<br />
Commissioner etc Regionai Municipality<br />
<strong>of</strong>Duftm forThe Corporation <strong>of</strong> the<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
rXpires January 28 2012<br />
9503P 2010101 Page 3 <strong>of</strong> 8
I<br />
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate 00<br />
Contribution from spouse 00<br />
Total from each single contributor totalling<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
more than 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or<br />
spouse Is 150 00<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 150 00<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Kerr Cameron 7 Pomeroy Crt Georgetown<br />
ON L7G 5W9 200<br />
Additional information is listed on separate supplementary<br />
attachment Total 200<br />
9503P 2010101 Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Publication Partners Ltd<br />
345 Kingston Rd <strong>Pickering</strong> ON Garth Atkinson A 750 00<br />
LIV IAl<br />
Doumouras Properties<br />
Ltd M4J 50<br />
1562 Danforth Ave Toronto ON<br />
200<br />
Additional information is listed on separate supplementary attachment Total 950 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on<br />
separate supplementary attachment<br />
Total<br />
Total Part 11 Contributions 150<br />
9503P 2010101 Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
f 12B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2B include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Is<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy m mdd<br />
Signs 2010<br />
05 Lakeview Signs 200 200 400<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010101<br />
400<br />
Page 7 <strong>of</strong>8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No<br />
Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
v<br />
Ministry <strong>of</strong> municipal affairs Financial Statement Auditor s <strong>Report</strong><br />
Ontario and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination I ap l0 C c 1 Q to ld lb y<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle In<br />
CIAWAIN<br />
Pt<br />
Mailing Address<br />
Suite Unit No Street No Street Nam<br />
g AlaIK Z<br />
Province<br />
Postal Code<br />
<strong>City</strong> Town<br />
Pi 0 r c 91 M 6 c Imo i v i S<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Name <strong>of</strong><br />
Home<br />
<strong>of</strong>fice for which the sought election<br />
candidat e Ward<br />
Name <strong>of</strong> Municipalit<br />
r R<br />
Name or No if any<br />
rLc G<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk r was J r<br />
2 Surplus or deficit from previous election<br />
I s<br />
3 Total contributions received from Schedule 1<br />
Is 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
is Z j 3<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is<br />
6 Total <strong>of</strong> all campaign expenses from Box C 1<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en franpis Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
2 GC SCE 6 G<br />
3 r U<br />
Total Campaign Period Income<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
D c<br />
C1<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee<br />
G<br />
X07<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs j 2<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 2 3 C3<br />
Total Campaign Period Expenses C2<br />
C3<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 C 3 2<br />
C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E1<br />
E2<br />
E3<br />
Part 11<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
l a candidate in the<br />
T municipality <strong>of</strong><br />
P t hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attache upporting schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the<br />
on<br />
yyyy mm<br />
p<br />
nCAC 1<br />
atv<br />
lcl U n<br />
Signature <strong>of</strong> Clerk or Commissioner Sig<br />
a <strong>of</strong> andidate<br />
dd I d aC j<br />
ao o 25<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFIC 10 COMMISSIONER<br />
PURSUANT TO SECTION 1121<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or<br />
spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributionsfrom candidate or spouse<br />
p<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Is<br />
Less<br />
Contribution returned or<br />
payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
C<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
l v A H K r<br />
57 L t<br />
rAtI2 PQ9i<br />
Zoo<br />
SL rL 1 loe<br />
Additional information is listed on separate supplementary attachment Total Q<br />
2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part If Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Date<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part 11 Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses<br />
Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
YYYy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
i<br />
I<br />
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free<strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
i<br />
AUDITOR S REPORT<br />
kuendtland<br />
CHARTERED ACCOUNTANTS<br />
TO<br />
Doug Dickerson<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Assets and Liabilities <strong>of</strong> Doug Dickerson candidate for the campaign period <strong>of</strong> May 4 2010 to December<br />
31 2010 for the election held on October 25 2010 These financial statements are the responsibility <strong>of</strong><br />
Doug Dickerson candidate Our responsibility is to express an opinion on these financial statements based<br />
upon<br />
our audit<br />
Except as explained in the following paragraph we conducted our audit in accordance with Canadian<br />
generally accepted auditing standards Those standards require that we plan and perform<br />
reasonable assurance that the financial statements are free <strong>of</strong> material misstatement An audit includes<br />
an audit to obtain<br />
the amounts and disclosures in the financial statement An<br />
examining on a test basis evidence supporting<br />
audit also includes assessing the accounting principles used and significant estimates made by the<br />
candidate as well as evaluating the overall presentation <strong>of</strong> the financial statement<br />
Due to the inherent nature <strong>of</strong> the transactions inherent in an election campaign it is impractical through<br />
auditing procedures to determine that the accounting records include all donations <strong>of</strong> goods and services<br />
and receipts and disbursements Accordingly our verification <strong>of</strong> these amounts was limited to ensuring the<br />
the financial statements reflect the amounts recorded in the candidate s accounting records in accordance<br />
with the accounting procedures established by the Municipal Elections Act 1976 and we were unable to<br />
determine whether any adjustments might be necessary to income and expenses assets and liabilities and<br />
surplus deficit<br />
In our<br />
opinion except for the effect <strong>of</strong> any adjustments if any which we might have determined to be<br />
necessary had we been able to satisfy ourselves as to the completeness <strong>of</strong> the records as described in the<br />
preceding paragraph these financial statements present fairly in all material respects the financial position<br />
<strong>of</strong> the candidate s election campaign as at December 31 2010 and the income and expenses for the<br />
campaign period from May 4 2010 to December 31 2010 and the determination <strong>of</strong> surplus deficit and<br />
the disposition <strong>of</strong> surplus in accordance with the accounting treatment prescribed by the Municipal<br />
Elections Act 1996<br />
The Municipal Elections Act 1996 does not require us to report nor was it practical for us to determine<br />
that contributions reported include only those which may be properly retained in accordance with the<br />
provisions <strong>of</strong> the Municipal Elections Act 1996<br />
RENAUD RUTLAND CHARTERED ACCOUNTANTS LICENSED PUBLIC ACCOUNTANTS<br />
<strong>Pickering</strong> Ontario March 16 2011<br />
Marc A Renaud<br />
307 High Street Whitby<br />
Edward Rutland<br />
Ontario LIN 51 17 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario Ll V 4N7<br />
Tel 905 666 2720 Fax 905 666 1042 Tel905 3023 509 Fax 905 6895 509<br />
marcCilrenAUClrutland com<br />
ed@renaudiudand com
te<br />
s <strong>Report</strong><br />
Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 05 04 to 201<br />
12 31<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Doug<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1203 Fieldstone Circle<br />
Dickerson<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong><br />
On UX 1B3<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 839 3684 905 839<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
city<br />
3684 dougdickerson ca<br />
councillor ward 2<br />
Name <strong>of</strong> Municipality<br />
Ward Name or No if any<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was<br />
Is 19 154 20<br />
2 Surplus or deficit from previous election Is 10 593 05<br />
3 Total contributions received from Schedule 1 I 39 111 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
Is 331 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 17 387 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 50 718 00<br />
7 Election campaign surplus deficit from current election from Box E<br />
I 1014 00<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E Is<br />
00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 05 04 2010 12 31 Doug Dickerson<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 10 593 00<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 39 111 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income Is 49 704 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 5622 00<br />
Bank charges 143 00<br />
Brochures 1983 00<br />
Interest on loan<br />
Inventory<br />
contributed to candidate s campaign Schedule 3<br />
Meetings hosted 2037 00<br />
Nomination filing fee<br />
Office expenses<br />
Phone and or Internet 1523 00<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 19 050 00<br />
Signs 2973 00<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 331 00 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 100<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation notices 16 094 00<br />
Expenses<br />
1<br />
2<br />
3<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1 Postage for thank you letters 193 00<br />
2<br />
3<br />
Subtotal 17 387 00<br />
C3<br />
Total Campaign Period Expenses C2 C3 Is 50 718 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 1014 00<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash 877 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 1891 00<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
Is<br />
877 00<br />
3<br />
Total Liabilities Is 1891 00<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 1014 00 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 1014 00<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination 101 400 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I Doug Dickerson<br />
<strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
E2<br />
Declared before clerk or commissioner<br />
in the 0 L J I Qt 14<br />
on yyyy mm dd<br />
A<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature<br />
<strong>of</strong> Candidate<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
3A DIANNE 4 3ARKER<br />
Crammissioner etc Reglonal Municipality<br />
tMmam<br />
forTheCorporation<strong>of</strong>the<br />
r <strong>of</strong> <strong>Pickering</strong><br />
es January 28 2012<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or<br />
1100 39<br />
spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 39 111 00<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment Total 13 000<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
i<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment Total 26 111 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
Is<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2Fund Raising Function<br />
Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
2A<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Is<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
Is<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign<br />
Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
<strong>Pickering</strong><br />
Contact Person<br />
Last Name<br />
First Name<br />
Date yyyy mm dd<br />
2011 03 16<br />
Rutl and Edward 116<br />
Address<br />
Suite Unit No Street No Street Name<br />
1024 Rouge Valley Drive<br />
<strong>City</strong> Town<br />
<strong>Pickering</strong><br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
666 905 2720 ext 905 666<br />
ON<br />
1042 ed@renaudrutland com<br />
Licence No<br />
Postal Code<br />
L1 V 4N7<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
41<br />
INDIVIDUAL CONTRIBUTIONS<br />
Steve DeGuise 750 00<br />
139 Indian Lake Rd<br />
RR 1<br />
Elgin<br />
KOG 1E0<br />
i<br />
Jules Kronis 100<br />
45 Timberlane Dr<br />
Downsview M31 13<br />
E Jerzykiewicz 750 00<br />
612 1305 Wilson Ave<br />
Downsview M3M 12<br />
M Trzcinski 750 00<br />
86 Mountainberry Rd<br />
Brampton 161121 7<br />
K Trzcinski 750 00<br />
86 Mountainberry Rd<br />
Brampton<br />
L6R 21 7<br />
L Trzcinska 750 00<br />
86 Mountainberry Rd<br />
Brampton161121 7<br />
J Winberg 250 00<br />
26 Breen Cres<br />
Willowdale M213 1Z7<br />
T Jewitt 100<br />
1212 Cedarcr<strong>of</strong>t Cres<br />
<strong>Pickering</strong><br />
UX 1S1<br />
WP Wilder 200<br />
Box 105 Ste 4802<br />
40 King St W<br />
Toronto M51 3Y2<br />
V Gupta 750 00<br />
562 Renforth Dr<br />
Etobicoke M9C 2N2<br />
N Latinovich 750 00<br />
151 Spinnaker Way<br />
Concord L4K 4C3
N Balduzzi 750 00<br />
58 Glenhuron Dr<br />
Barrie L4M 6T4<br />
B Browning 750 00<br />
15 2230 Walkers Line<br />
Burlington<br />
L7M 3Y8<br />
D Goyo 750 00<br />
86 Glacier Crt<br />
Maple L6A 2V6<br />
A Sirohi 500<br />
757 Sheppard Ave<br />
<strong>Pickering</strong><br />
L1V 1G4<br />
J Overzet 500<br />
655 Audley Rd S<br />
Ajax LIZ OC6
VS Aggarwal 250 00<br />
2408 30 Malta Ave<br />
Brampton L6Y 4S5<br />
B Penny 300<br />
1062 Dunbarton Rd<br />
<strong>Pickering</strong><br />
L1V 1G8<br />
A Debruin 300<br />
RR 1<br />
Sunderland LOC 1H0<br />
F Reisman 750 00<br />
118 4800 Sheppard Ave E<br />
Toronto M1S 4N5<br />
H Kosciow 750 00<br />
3214 Rolling Stone Crt<br />
Mississauga L5B 4G4<br />
M Bogusz 750 00<br />
208 228 Galloway Rd<br />
Scarborough<br />
M1E 5G6<br />
G Goyo 750 00<br />
70 Kokanee Crt<br />
Maple L6A 2V6<br />
TOTAL 13 000
CORPORATION<br />
TRADE UNION CONTRIBUTIONS<br />
Rose Investments 750 00<br />
156 Duncan Mill Rd<br />
Suite 12<br />
Toronto M36 3N2<br />
Davlind Management Inc 750 00<br />
801 150 Ferrand Dr<br />
Toronto M3C 3E5<br />
Picore Holdings<br />
80 Queen St<br />
Kingston<br />
K7K 6W7<br />
Limited 750 00<br />
Binns Inc 400<br />
333 Kingston Rd<br />
<strong>Pickering</strong><br />
L1V 1A1<br />
Viva <strong>Pickering</strong> Limited Partnership 750 00<br />
206 3845 Bathurst St<br />
Toronto M3H 3N2<br />
Spar Marathon Ro<strong>of</strong>ing Supplies Ltd 750 00<br />
3689 Weston Rd<br />
Weston M9L 1W4<br />
IBEW Local 894 400<br />
3 380 Lake Rd<br />
Bowmanville L1C 4138<br />
2143087 Ontario Limited 700<br />
207 2985 Drew Rd<br />
Mississauga<br />
L4T 0A1<br />
Royal Auto Body 500<br />
971 Alliance Rd<br />
<strong>Pickering</strong><br />
L1W 3M8<br />
Doumouras Properties Ltd 400<br />
PO Box 72040<br />
1562 Danforth Ave<br />
Toronto M4J 1N4<br />
Intellimetre Canada Inc 100<br />
1125 Squires Beach Rd<br />
<strong>Pickering</strong> L1W 3T9
Concordian Mgmt BMC Bayly 750 00<br />
102 7077 Keele St<br />
Concord<br />
L4K OB6<br />
Redfords Insurance Brokers Ltd 750 00<br />
1903 Valley<br />
<strong>Pickering</strong><br />
Farm Rd<br />
L1V 1X6<br />
Bitondo s Market Limited 750 00<br />
RR 1<br />
Locust Hill LOH 1JO<br />
1061475 Ontario Limited 750 00<br />
9 1295 Wharf St<br />
<strong>Pickering</strong><br />
L1W 1A2<br />
Durham Region<br />
115 Albert St<br />
Oshawa L1H 4113<br />
Labour Council 111<br />
Louisville Homes 750 00<br />
11 Colonel Danforth Trail<br />
Toronto M1C 1P8<br />
Fourteen Estates Limited 200<br />
96 Cawker s Cove Rd<br />
Port Perry 191 1116<br />
Certworth Services Inc 750 00<br />
757 Sheppard Ave<br />
<strong>Pickering</strong><br />
L1V 1G4<br />
Edukids Child Care Centre Ltd 250 00<br />
459 Broadgreen St<br />
<strong>Pickering</strong><br />
L1W 16 31<br />
Mirage Steel Limited 750 00<br />
23 Automatic Rd<br />
Brampton WS 4K6
I<br />
i<br />
i<br />
Mattamy Development Corporation 400<br />
2360 Bristol Circle<br />
Oakville L6H 6M5<br />
<strong>Pickering</strong> Square<br />
300 1550 Kingston Rd<br />
<strong>Pickering</strong><br />
L1V 1C3<br />
Inc 100<br />
Beam Hill Developments<br />
1 1850 Ironstone Manor<br />
<strong>Pickering</strong><br />
L1W 3W9<br />
Ltd 750 00<br />
Runnymede Development Corporation Ltd 750 00<br />
1051 Tapscott Rd<br />
Toronto M1X 1A1<br />
Chieftan Development Corporation 750 00<br />
111 23 Lesmill Rd<br />
Toronto M313 3P6<br />
Pipe<br />
Fitters Local 46 500<br />
936 Warden Ave<br />
Toronto M 1 L 4C9<br />
Grant Morris Associates Ltd 650 00<br />
397 Sheppard Ave<br />
<strong>Pickering</strong><br />
L1V 1E6<br />
Logic Const Consultation Management 750 00<br />
11 Colonel Danforth Trail<br />
Toronto M1C 1138<br />
Sabourin Kimble Associates Limited 250 00<br />
110 Old Kingston Rd<br />
Ajax<br />
UT 2Z9<br />
Monarch Kitchen Bath Centre Limited 250 00<br />
6 1020 Brock Rd S<br />
<strong>Pickering</strong><br />
L1W 12 31<br />
The Sernas Group 250 00<br />
41 Scotia Crt<br />
Whitby<br />
UN 8Y7
1008833 Ontario Inc 500<br />
252 1050 Brock Rd S<br />
<strong>Pickering</strong><br />
L1W 3X4<br />
Direct Line Environmental Corp 500<br />
1070 Toy Ave<br />
<strong>Pickering</strong><br />
L1W 3131<br />
Sparta<br />
Homes Inc 500<br />
2091 Liverpool Rd<br />
<strong>Pickering</strong><br />
UX 1E3<br />
Sort Can Recycling Ltd 500<br />
102 1048 Toy Ave<br />
<strong>Pickering</strong><br />
L1W 3P1<br />
2085026 Ontario Ltd 750 00<br />
1211 Kingston Rd<br />
<strong>Pickering</strong><br />
L1V 6M5<br />
Maylar Construction Limited 750 00<br />
9488 McCowan Rd<br />
Markham L3P 313<br />
Alltemp Products Company Limited 750 00<br />
827 Brock Rd S<br />
<strong>Pickering</strong><br />
L1W 312<br />
Massey<br />
Restaurants Ltd 250 00<br />
774 Liverpool Rd S<br />
<strong>Pickering</strong> L1W 1118<br />
Bayfield Realty Advisors Inc 250 00<br />
904 2300 Yonge St<br />
Toronto M413 1E4<br />
Invar Building Corporation 500<br />
301 220 Duncan Mill Rd<br />
Toronto M313 315<br />
Brockington Plaza Inc 500<br />
17 Portsmith Rd<br />
North York M2L 2W7
t<br />
Linli Management Limited 200<br />
206 2900 Steeles Ave E<br />
Thornhill BT 4X1<br />
Metrus Development Inc 2 500<br />
300 30 Floral Parkway<br />
Concord L4K 4112<br />
Alfin Financial Corp 750 00<br />
44 Upjohn Rd<br />
Toronto M313 2W1<br />
TACC Construction Ltd 500<br />
270 Chrislea Rd<br />
Woodbridge<br />
141 8A8<br />
I<br />
Creative Outdoor Advertising 750 00<br />
2402 Stouffville Rd<br />
i<br />
Gormley<br />
LOH 1G0<br />
<strong>Pickering</strong> Square 1986 Inc 100<br />
300 1550 Kingston Rd<br />
<strong>Pickering</strong><br />
L1V 1C3<br />
Rougemount Square 100<br />
300 1550 Kingston Rd<br />
<strong>Pickering</strong><br />
L1V 1C3<br />
TOTAL 26 111
Ontario and Housing<br />
<strong>of</strong> Municipal Affairs Financial Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
For the campaign period from day candidate filed nomination<br />
E primary filing reflecting finances to December 31 or 45th day after voting day in a by election<br />
YYYY MM<br />
YYYY MM DD<br />
DD<br />
o20 U g MO to<br />
12610110 0<br />
Supplementary filing including finances after December 31 or 45h day after voting day in a by election<br />
Box A Name <strong>of</strong> Candidate<br />
Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
l<br />
M kL4 IN NO 1<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
f<br />
pick<br />
116 i 0 L UJ 3T3<br />
Telephone No incl area code Fax No Email Address<br />
usiness<br />
Home<br />
35vt 059OZO<br />
14<br />
N me <strong>of</strong> <strong>of</strong>fice for which e candidate sought election Ward Name or No if any<br />
y<br />
Name <strong>of</strong> Municipality<br />
pickfie<br />
BozBStammary <strong>of</strong> Campaign Incomeand expenses<br />
1 My spending limit as issued by clerk was Is 9<br />
e<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1 Is Joe J<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 40<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E I<br />
W<br />
9503P 2010<br />
@ Queen s Printer for Ontario 2010<br />
Disponible<br />
en fran ais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY<br />
0<br />
MM<br />
0q<br />
INCOME<br />
YY MM DD lelwo<br />
Candidate s surplus from immediately preceding election released by the clerk Is<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functionsnot deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
3<br />
Total Campaign Period Income<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C3<br />
Total Campaign Period Expenses C2 C3 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C17C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
L<br />
Box D Statement<strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 407<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination<strong>of</strong> Surplusor Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E2<br />
E1<br />
E2<br />
E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
a<br />
1 lCrl<br />
candidate in the municipality <strong>of</strong><br />
financial statements and attached sup<br />
rting schedules are true and correct<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the<br />
cehf Id<br />
on<br />
yyyy mm dd ao11 I C a 3<br />
i<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature<br />
o<br />
ate<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
<strong>of</strong> Candidate<br />
ISA DIANNE HARKER<br />
Commissioneretr Reoonal Munidpality<br />
<strong>of</strong> DurIrn forThe Corporation <strong>of</strong> the<br />
Cty <strong>of</strong> <strong>Pickering</strong><br />
pins January 28 2012<br />
9503P 2010101 Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
f<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Date<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
12A<br />
Number <strong>of</strong> tickets sold c 2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2B include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full details eg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description<br />
Date Acquired Supplier<br />
Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description<br />
Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign<br />
Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
I<br />
i<br />
i<br />
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope<br />
<strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010101 Page 8 <strong>of</strong> 8
The Corporation <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
<strong>Pickering</strong> Civic Complex<br />
One The Esplanade<br />
<strong>Pickering</strong> ON L1 V 6K7<br />
1811 BICENTENNIAL 2011 city<strong>of</strong>pickering com<br />
PICKE RING<br />
Administration Department<br />
Legal Legislative Services Division Clerk s Office<br />
T 905 420 4611<br />
Toll Free1866 2760 683<br />
TTY 420 905 1739<br />
Fax 420 905 9685<br />
Email<br />
clerks@city<strong>of</strong>pickering com<br />
March 28 2011<br />
SENT VIA REGISTERED MAIL<br />
Brian Evely<br />
1946A Faylee Crescent<br />
<strong>Pickering</strong> ON<br />
L1V 2V6<br />
Subject 2010 Municipal Elections Financial Statement<br />
FileA2000 001 11<br />
TAKE NOTICE that you are in default <strong>of</strong> the requirements <strong>of</strong> the Municipal Elections<br />
Act 1996 as amended because you failed to file documents namely your financial<br />
statement with the <strong>City</strong> Clerk as required by Section 78 <strong>of</strong> the Municipal Elections Act<br />
1996 as amended on or before200 pm on Friday March 25 2011<br />
As a result you are now ineligible to be elected or appointed to any<br />
Municipal Elections Act 1996 as amended applies until the next regular<br />
taken place<br />
in 2014<br />
<strong>of</strong>fice to which the<br />
election has<br />
If you have any question regarding this matter please feel free to contact me directly at<br />
420 905 4660 ext 2019<br />
Yours truly<br />
Debbie Shields<br />
<strong>City</strong> Clerk<br />
DS kn
l Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 06 24 to 2010 12 31<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<br />
or 45th day after voting day in a by election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Hraiki Laurissa M<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1421 Sandhurst Crescent<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong> ON L 1 V6Y8<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
416 953 7598 laurissa@laurissahraiki ca<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Ward Name or No if any<br />
<strong>City</strong> Councillor 3<br />
Name <strong>of</strong> Municipality<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was so to<br />
2 Surplus or deficit from previous election 00<br />
3 Total contributions received from Schedule 1 3790 51<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 3013 70<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 489 51<br />
6 Total <strong>of</strong> all campaign expenses from Box C 3503 21<br />
7 Election campaign surplus deficit from current election from Box E<br />
287 3<br />
8 Contributions refunded to candidate or spouse from Box E 287 30<br />
9 Amount paid to clerk from Box E 00<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 06 24 2010 12 31 Laurissa Hraiki<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 471 51<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 319 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income r 3790 51 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 640 63<br />
Bank charges 787<br />
Brochures 864 45<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
Nomination filing<br />
contributed to candidate s campaign Schedule 3<br />
fee 100<br />
Office expenses 92 49<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 909 32<br />
Other provide full details<br />
1TShirts 98 94<br />
2 Website 300<br />
3<br />
Subtotal<br />
3013 70 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV 489 51<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 489 51 C3<br />
Total Campaign Period Expenses C2 C3 3503 21 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is 287 30<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at Dec 31 2010<br />
Assets<br />
Cash 00<br />
Accounts receivable 00<br />
Value <strong>of</strong> inventory retained from Schedule 4 617 20<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 00<br />
Borrowings overdraft 00<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Is<br />
Is<br />
6720<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 287 30 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 287 30<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus 287 30<br />
00 E2<br />
Total Determination<br />
00 E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I Laurissa Hraiki<br />
a candidate in the municipality <strong>of</strong><br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
financial statements and attached supporting schedules are true and correct<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or<br />
in the<br />
commissi oner<br />
aT PC 1 Cr<br />
on yyyy mm dd a0 t 1 O 3<br />
LJ Ca<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
SLO t o 7 a5<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
e<br />
DEBBIE M SHIELDSCITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 10<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
Signature <strong>of</strong> Candidate<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
I<br />
Schedule 1<br />
Contributions<br />
Pan I<br />
Contribution<br />
Contribution from candidate 471 51<br />
Contribution from spouse<br />
Total from each single contributor totalling<br />
more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse 2468 00<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse Is<br />
851 00<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or<br />
payable to the contributor<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 3790 51<br />
Total contribution from anonymous sources<br />
1A<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 1113<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Ryan Papadimitriou 11 Canning<br />
Crt Markham Ontario L3S2W5 200<br />
Dianne Hraiki 1421 Sandhurst Cres <strong>Pickering</strong> Ontario I 1 v6y8 500<br />
Evgenia Shapas 1419 Sandhurst Cres pickering<br />
Vangie Papadimitriou 11 Canning<br />
ontario I I v6r4 300<br />
Crt Markham Ontario 13S2W5 300<br />
Michael Shapas 29 Ada Gardens Markham On 16bOg2 300<br />
Rose Shapas 59 Burcher Rd Ajax On I 1 s2p9 100<br />
Additional information is listed on separate supplementary attachment Total 1700<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Source Energy Inc 3950 14 x Avenue Suite 509<br />
Markham Ontario 13r Oa9<br />
Chris Kalcovski Chris Kalcovski 150 00<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Curves <strong>Pickering</strong> East<br />
1050 Brock Rd Unit 5 <strong>Pickering</strong><br />
On L1W3X4<br />
23Month Memberships 198 00<br />
Ryan Papadimitriou<br />
1 1 canning crt Markham On<br />
13s2w5<br />
Website Setup 300<br />
Daniel Lisi<br />
33 Erskine Avenue Suite 502<br />
Toronto On M4P 1 y6<br />
Toronto FC Tickets for raffle 120 00<br />
Additional information is listed on separate supplementary attachment Total 618 00<br />
Total Part II Contributions<br />
2468 00<br />
9503P 2010101 Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Date<br />
Additional schedule for each event or activity<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
2010 07 24 Fundraiser BBQ<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit 00 15 2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold 26 2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1 390 00<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1 23month Gym Memberships 198 00<br />
2 Toronto FC Tickets 120 00<br />
3 Raffle guessing game 266 00<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1 584 00<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink 111 68<br />
Entertainment<br />
Other provide full details<br />
1 Movie Tickets for raffle 98 25<br />
2<br />
Guessing Game 85 33<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C 171 51<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Election Signs 2010<br />
ODee Display Graphics 704 80 563 20<br />
Wooden Stakes 2010<br />
08 Millwork Home Centre 054 100 54 00<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 617 20<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ontario Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditors <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination I ao 10 0 0 4 I<br />
to O r p<br />
I a<br />
13<br />
X 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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Mailing Address<br />
OLLcn<br />
Suite Unit No Street No Street Name<br />
MiCHAE L<br />
a30a EA VE<br />
<strong>City</strong> Town Province Postal Code<br />
Pi cKEkG 4L C i X a E<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
qOS L4 Po3 M ciEL Da E RoG<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Name <strong>of</strong> Municipality<br />
Ward Name or No if any<br />
C TY Cou Cf LLVl 3<br />
ClTy <strong>of</strong> PkEzJ<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
2s COV<br />
1 My spending limit as issued by clerk was<br />
3 O 6<br />
2 Surplus or deficit from previous election Is B<br />
3 Total contributions received from Schedule 1<br />
3 7 3 4<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 3 4<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C Is<br />
oL jO<br />
6 Total <strong>of</strong> all campaign expenses from Box C 3 q<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is 07 c 4 1<br />
8 Contributions refunded to candidate or spouse from Box E<br />
Is<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
62 010 C C o o 1 3 3 CMAF L 0 pLkc<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 19<br />
Contributions from candidate 3 b q<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 49<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income 3 4 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 3 cSb<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee<br />
Office expenses<br />
g<br />
3 q f<br />
Q g<br />
DO<br />
S<br />
3L<br />
Phone and or Internet 07<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
30 ob<br />
Subtotal 3 4 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
113 Ji<br />
Voting day party appreciation notices 3 3 i<br />
Expenses<br />
1<br />
2<br />
3<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal a to 50 C3<br />
Total Campaign Period Expenses C2 C3 3 e C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 23<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Sox D Statement <strong>of</strong> Assets and Ui Oi rttes as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Boxlt2t rent ef Determination <strong>of</strong>Surplus or Defic f andDsppsiti nQf SGrptt s<br />
Part I<br />
Determination <strong>of</strong> Surplus<br />
or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction tB E2<br />
Surplus or deficit for the campaign period E1 E2 a<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
E1<br />
Total Determination<br />
E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
l M C HA8t Qd LE a candidate in the municipality <strong>of</strong><br />
V C1 E 2 n 6 hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attached supporting schedules are true and correct<br />
Declared before clerk or<br />
commission er<br />
in the<br />
C t u 0 J t t C<br />
1<br />
on<br />
yyyy mm dd 19<br />
3 i v G<br />
tdt 4<br />
Signature <strong>of</strong> Clerk or Commissioner ig ture <strong>of</strong> Candidate<br />
1q 9010 11<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
34o 4<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Is<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1<br />
1A<br />
Total Amount <strong>of</strong> Contribution j y 9 3<br />
Total contribution from anonymous sources g 1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name<br />
Address<br />
Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2 Fund Ra iin Function<br />
Additional schedule for each event or activity heldis are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2B include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Is<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> CampaignGoods and Materials from Previous Campaign<br />
Used in Candidate sCampagn<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End co Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010101 Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Pape 8 <strong>of</strong> 8
MARK SPURRELL November 17 2010<br />
TAX PREPARATION<br />
PLANNING<br />
HST Reg 87076 3976<br />
Name Mr Michael Odle<br />
Account<br />
Services RECEIVED<br />
Amount charged<br />
Tax Preparation CITY OFQ1r KERING<br />
Financial Services<br />
Other specify<br />
See notes below<br />
N O V 2 2 2010<br />
100<br />
CLERK S DIVISION<br />
Total 100<br />
Charged<br />
Plus 13 HST 13 00<br />
Total 113 00<br />
Amount paid<br />
Amount owing<br />
113 00<br />
Notes Fees for preparation <strong>of</strong> Financial Statement for municipal<br />
election contributions and expenses based on the information provided<br />
A copy is provided for your records<br />
Thank you for your business It is very much appreciated<br />
Please make cheque payable to Mark Spurrell<br />
Thank you again for your patronage<br />
Mark Spurrell<br />
201 58 Rossland Road West<br />
Oshawa Ontario<br />
L1G 2V5<br />
905 571 4180<br />
Fax 905 571 3048<br />
Email<br />
mark<br />
spurrell@bellnet ca
enaud<br />
utland<br />
CHARTERED ACCOUNTANTS<br />
AUDITOR S R<br />
PORT<br />
10e<br />
David Pickles<br />
Municipal Elections Act 1996 Section 78<br />
We have audited the Statements <strong>of</strong> Campaign Period Income and Expenses Disposition <strong>of</strong> Surplus and<br />
Asascts and Liabilities <strong>of</strong> David Pickles candidate for the campaign period <strong>of</strong>Januag 6 2010 to<br />
December 31 2010 for the election held on October 25 2010 These financial statennents are the<br />
responsibility <strong>of</strong> David Pickles andidate Our responsibility is to xpress an opinion<br />
on these financial<br />
statements based upon out audit<br />
Except as explained in the tOilowing paragraph<br />
generally accepted auditing standards Those standards require that we<br />
plan and perform<br />
we conducted our audit in accordance with Canadian<br />
an audit to obtain<br />
reasonable assurance that the financial statermits are free <strong>of</strong> material misstateanent An audit includes<br />
exanlining on a test basis evidence supporting the amounts and diclosures in the financial statement An<br />
audit also includes assessing the accourlting principles used and significant estimates made by the<br />
candidate as well as evaluating lie overall presentation <strong>of</strong> thz financial statement<br />
Due to the inherent nature <strong>of</strong> the iransictioils inherent in an election canlpain it is innpracti al through<br />
auditing procedures to determine that the accounting cords include all donations <strong>of</strong> goods lnd services<br />
and receipts and disbursements Accordingly<br />
our verifl ation <strong>of</strong>the se amounts vas limited to ensuring the<br />
the finarcial statements reflect lie amous ts recorded 101 candidate s accountln<br />
records in aceordancs<br />
with the accolnlting procedureseiabiished by the Munic paifIectic iis Act 1976 and we wereiti io<br />
d terrrtr<br />
vdiether any ad ustn ients rinl<br />
Surplus<br />
ht be necessary t7 Inco nis and expenses assets and ha tt ltit ai i<br />
iii Jir rp alOneCept fiCtcfl ect o allyaJ istrients if ally wlnlCii we mli lnt have determined to o<br />
n<br />
cslry h4ad we been able to satisfy ourselves as to the corrpleterncss <strong>of</strong> the records as described in the<br />
g<br />
paragraphtlese financialsi atements present fairly ir all material respects the financial position<br />
cndidat s election campaign as A December 31 2010 and their conne and cxpeliscs for the<br />
c<br />
vipal<br />
period from January 6 2010 to December 31 2010 lid the deiert nination<strong>of</strong> surplusdc vit<br />
at 411 disposition <strong>of</strong> Surplus in accordance with the accountlna treatment prescribed b Lhe Nluil<br />
it ipal<br />
rt<br />
CIP Isi 1 Act 11996<br />
Eic MunicipalElcticr is A 1996 do a notIcquire lls to report nor was it prai cal fit us to deterrnitne<br />
qfitCSht7t tCtinS epo ted include only tho e t hih may he troj7 rly retained in aci ordarl c willi tire<br />
pro 1tons <strong>of</strong>tn Mirli irgdfiec tions Act 1996<br />
Zf<br />
D KIY LAND C1tAN ERF AtCi lidtAN 14 cSED PUBLICACCOLYNTANTS<br />
Pick rine<br />
ntario<br />
201 I<br />
Marc A Renaud<br />
Edward Rutland<br />
307 High Street Whitby Ontario LIN 5H7 1024 Rouge Valley Drive <strong>Pickering</strong> Ontario Ll V 4N7<br />
Tel905 666 2720 Fax 905 666 1042 Tel905 3023 509 Fax905 6895 509<br />
mai<br />
c@renaudrutiand com<br />
ed@renaudrutland com
s <strong>Report</strong><br />
Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 06 to 2010 12 31<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Pickles<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
1620 Baggins Street<br />
David<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
<strong>Pickering</strong><br />
ON L1X 2E2<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 426 5442 905 686<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
7746 dpickles@rogers com<br />
Councillor ward 3<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
1 My spending limit as issued by clerk was 26 306 00<br />
2 Surplus or deficit from previous election Is 309 00<br />
3 Total contributions received from Schedule 1 22 505 00<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 19 869 00<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is 2337 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 22 206 00<br />
7 Election campaign surplus deficit from current election from Box E 299 00<br />
8 Contributions refunded to candidate or spouse from Box E<br />
Is<br />
9 Amount paid to clerk from Box E<br />
Is<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 06 2010 12 31 David Pickles<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 22 205 00<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1 inventory from previous campaign<br />
300<br />
2<br />
3<br />
Total Campaign Period Income Is 22 505 00 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising 4210 00<br />
Bank charges 140 00<br />
Brochures 480 00<br />
Interest on loan<br />
Inventory<br />
Meetings<br />
contributed to candidate s campaign Schedule 3 300<br />
hosted 285 00<br />
Nomination filing fee<br />
Office expenses 3529 00<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 802 00<br />
Other provide full details<br />
1 Mailing<br />
costs 280 00<br />
2 Volunteer meals and travel 3843 00<br />
3<br />
Subtotal 19 869 00 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 503 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party appreciation notices 1834 00<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
2337 00 C3<br />
Total Campaign Period Expenses C2 C3 22 206 00 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1 C4 Is 299 00<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
As3ets<br />
Cash 802 00<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule a<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 802 00<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
503 00<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
503 00<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
299 00 E1<br />
309 00 E2<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 10 00<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
E3<br />
Box F Declaration<br />
fTC<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial atements and attached upporting schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the 1 u Lc<br />
l y1 Gy<br />
on yyyy mm dd cZ 0 l 1 03 0<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
07 a0h 03<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
Signature <strong>of</strong> Candidate<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 1 t2<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Pait I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or 22 205 00<br />
spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
and services where value is 100 or less<br />
include all goods<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Less<br />
Contribution returned or payable to the contributor<br />
1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 22 205 00<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1 A<br />
1 B<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment Total 4700<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment Total 17 505 00<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
I Additional information is listed on separate supplementary attachment<br />
Total Total PartII Contributions 22 205<br />
00 9503P 2010 01 Page 5 <strong>of</strong>
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
213<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Is<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
signs<br />
Lawrence Designs 750 40 300<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 300<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
y mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Chartered Accountant<br />
Municipality<br />
Date yyyy mm dd<br />
<strong>Pickering</strong> 2011<br />
03<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Rutland Edwarfd 116 mot 7<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
<strong>Pickering</strong><br />
1024 Rouge Valley Drive<br />
Province<br />
Telephone No incl area code Fax No Email Address<br />
905 706 6369 ext 905 666 1042<br />
On<br />
Postal Code<br />
L1V 4N7<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
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aj<br />
l Ontario Ministry <strong>of</strong> Municipal Affairs<br />
Financial Statement Auditor<br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 2010 01 04 to 2010 12 1<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 aby election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name<br />
3raney<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
265 Stover Crescent<br />
First Name<br />
Chris<br />
I<br />
Middle Initial<br />
<strong>City</strong> Town Province Postal Code<br />
<strong>Pickering</strong><br />
On L 1 V 6R1<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
905 4646 999 905 509<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Trustee Public Board<br />
Name <strong>of</strong> Municipality<br />
<strong>Pickering</strong><br />
2426 cbraney dtelus blackberry net<br />
BOX B Summary <strong>of</strong> Campaign Income and Expenses<br />
Ward Name or No if any<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
1 My spending limit as issued by clerk was 46 274 30<br />
2 Surplus or deficit from previous election 00<br />
3 Total contributions received from Schedule 1 4967 29<br />
4 My total campaign expenses that were subject to the spending limit were from Box C 5644 79<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 00<br />
6 Total <strong>of</strong> all campaign expenses from Box C 5644 79<br />
7 Election campaign surplus deficit from current election from Box E 677 50<br />
8 Contributions refunded to candidate or spouse from Box E 0<br />
9 Amount paid to clerk from Box E 00<br />
9503P 2010<br />
@ Queen s Printer for Ontario 2010<br />
Disponible en frani ais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
2010 01 04 2010 12 31 Chris Braney<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk 00<br />
Contributions from candidate 1956 18<br />
Contributions from spouse <strong>of</strong> candidate 00<br />
All other contributions 301 11<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income 00<br />
Other provide full details<br />
1<br />
2<br />
0<br />
3<br />
Total Campaign Period Income 4967 29 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
00<br />
00<br />
00<br />
918 69<br />
Bank charges<br />
10 73<br />
Brochures 1435 10<br />
Interest on loan 00<br />
Inventory<br />
contributed to candidate s campaign Schedule 3 677 50<br />
Meetings hosted 00<br />
Nomination filing fee 100<br />
Office expenses<br />
Phone and or Internet 00<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees 00<br />
Signs<br />
00<br />
Other provide full details<br />
1 Postage for brochures 2502 77<br />
2<br />
3<br />
Subtotal 5644 79<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit 00<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV 00<br />
Expenses related to compliance audit 00<br />
Expenses related to controverted elections 00<br />
Expenses related to recounts 00<br />
Voting day party appreciation notices 00<br />
Expenses<br />
related to candidate s disability provide details<br />
1 00<br />
2 00<br />
3 00<br />
Other provide full details<br />
1 00<br />
2 00<br />
3 00<br />
Subtotal is<br />
C3<br />
Total Campaign Period Expenses C2 C3 Is 5644 79 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 Is 677 50<br />
00<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at December 31st 2010<br />
Assets<br />
Cash 00<br />
Accounts receivable 00<br />
Value <strong>of</strong> inventory retained from Schedule 4 524 50<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets Is 524 50<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Is<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C 677 50 E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2 677 50<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
00 E2<br />
Total Determination Is 677 50 E3<br />
00<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible<br />
for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong> 0<br />
Box F Declaration<br />
I Chris Braney<br />
<strong>Pickering</strong><br />
financial statements and attached supporting<br />
schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner<br />
in the C l p<br />
f t<br />
CAL cai<br />
on yyyy mm dd oZO IL d 3<br />
i t<br />
Signature <strong>of</strong> Clerk or Commissioner Signature <strong>of</strong> Can idate<br />
90tk td ll<br />
s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 10<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
Date Filed in the Clerk<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 9<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate<br />
11956 18<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
00<br />
301 1 I 1<br />
Less Contribution returned or payable to the contributor 00<br />
00 1A<br />
Contribution paid or payable to the clerk<br />
Total Amount <strong>of</strong> Contribution 4967 29<br />
Total contribution from anonymous sources<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
00<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Georgia Braney 625 Brookside Drive Oshawa Ontario L I G 4G9 500<br />
Paul Sheehy 90 Hillside Drive Brampton Ontario L6S IA6 400<br />
Mary Jane Viejo 1273 Fawndale Road <strong>Pickering</strong> Ontario L I V 5S2 500<br />
Additional information is listed on separate supplementary attachment Total 1400<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
I<br />
I<br />
I<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
District 13<br />
OSST F 601 Palace Street Whitby<br />
Alison Wallace Alison Wallace 500<br />
Ontario LIN 6S5<br />
Durham Region Labour<br />
Council<br />
115 Albert Street Oshawa<br />
Ontario L I H 4R3<br />
Jim Freeman Jim Freeman 1 1 11<br />
Bradimar Corporation<br />
Sngi Capital Corp<br />
34 Vale Cresent Ajax Ontario<br />
LIS 4Y8<br />
268 Friendship Ave<br />
Scarborough Ontario M I C 4I 14<br />
Mary Neto Mary<br />
Neto 500<br />
Jose Suguitan Jose Suguitan<br />
500<br />
b<br />
Additional information is listed on separate supplementary attachment Total 1611 11<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Functions<br />
Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2A<br />
213<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 26 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Is<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Is<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010101 Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Election Signs 2006 09 12 600 96 576 00<br />
Wood Stakes 2006 09 12 050 203 101 50<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign 677 50<br />
Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Schedule 4<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Election Signs 2006 09 12 600 74 444 00<br />
Wood Stakes 12 2006 09<br />
050 161 80 50<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials 124 50<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town<br />
Province<br />
Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or<br />
Business As Business ManagerTCheque Signatory Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table I Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part 11 Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
I<br />
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is 2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2121 include in Schedule 1<br />
Part 11<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mrn dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010101 Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong> 10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong>8
Ministry <strong>of</strong> Municipal Affairs<br />
and Housing<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 4 J<br />
to<br />
aolQ<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
G<br />
<strong>City</strong> Town Province Postal Cod<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Hom<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candida sought election Ward Name or No if any<br />
Name <strong>of</strong> Municipality<br />
1 V<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was Is V<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1<br />
J<br />
4 My total campaign expenses that were<br />
subject to the spending limit were from Box C<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
I s<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E Is<br />
9 Amount paid to clerk from Box E<br />
9503P 2010<br />
Queen s Printer for Ontario 2010<br />
Disponible en fran ais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2 C3<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1<br />
C4<br />
C3<br />
C4<br />
9503P 2010101<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
PartIDetermination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box c<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E1<br />
E2<br />
E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible<br />
for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
financial statements and attached supporting schedules are true and correct<br />
a candidate in the municipality <strong>of</strong><br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
Declared before clerk or commissioner C ti C 1 ickXcr nG<br />
in the<br />
R i r o r<br />
rxvY<br />
on yyyy mm dd aD I t O A<br />
Is<br />
I<br />
J<br />
Signature <strong>of</strong> Clerk or Commissioner Signature<br />
<strong>of</strong> ndidate<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF BICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 10<br />
F111E<br />
AFFIDAVITS<br />
ACTOR<br />
OTAKING<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1 Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Is<br />
Note Goods and services must also be reported as expenses in Box C<br />
Is<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable<br />
to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table I Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on<br />
separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010101 Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admission charge per person may not exceed individual contribution limit Is 12A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2121 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
8<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
i Total Value<strong>of</strong> Inventory from Previous<br />
Campaign Usedin Candidate s<br />
Campaign Schedule4inventory<strong>of</strong> Campaign Goods and Materials at The End<strong>of</strong><br />
Campaign Description Date Acquired Supplier Unit Value Quantity Total<br />
Value mm<br />
dd Total Value<strong>of</strong> Inventory <strong>of</strong> Campaign Goods and<br />
Materials 9503P 2010 01 Page 7 <strong>of</strong>
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
C<br />
The Corporation <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
<strong>Pickering</strong> Civic Complex<br />
I One The Esplanade<br />
v G<br />
<strong>Pickering</strong> ON L1 V 6K7<br />
1811 BICENTENNIAL 2011 city<strong>of</strong>pickering com<br />
PICK E R I<br />
Administration Department<br />
Legal Legislative Services Division Clerk s Office<br />
T 905 420 4611<br />
Toll Free1866 683 2760<br />
TTY 905 420 1739<br />
Fax 420 905 9685<br />
Email<br />
clerksQacity<strong>of</strong>pickering com<br />
March 28 2011<br />
SENT VIA REGISTERED MAIL<br />
Ida Fogo<br />
1818 Dencourt Drive<br />
<strong>Pickering</strong> ON<br />
L1V 4Y2<br />
Subject 2010 Municipal Elections Financial Statement<br />
FileA2000 001 11<br />
TAKE NOTICE that you are in default <strong>of</strong> the requirements <strong>of</strong> the Municipal Elections<br />
Act 1996 as amended because you failed to file documents namely your financial<br />
statement with the <strong>City</strong> Clerk as required by Section 78 <strong>of</strong> the Municipal Elections Act<br />
1996 as amended on or before200 pm on Friday March 25 2011<br />
<strong>of</strong>fice to which the<br />
As a result you are now ineligible to be elected or appointed to any<br />
Municipal Elections Act 1996 as amended applies until the next regular election has<br />
taken place<br />
in 2014<br />
If you have any question regarding this matter please feel free to contact me directly at<br />
905 420 4660 ext 2019<br />
Yours truly<br />
hJ<br />
J<br />
Debbie Shields<br />
<strong>City</strong> Clerk<br />
DS kn<br />
I
Auditors<br />
ir Ontario Ministry <strong>of</strong> Municipal Affairs Financial Statement<br />
<strong>Report</strong> and<br />
Housing Form<br />
4 Municipal Elections Act 1996 Section<br />
78<br />
InstructionsAll candidates must complete Boxes A B C D E and F and Schedule 1All candidates must complete Schedules 2 3 and 4<br />
as appropriate Candidates who receive contributions or incur expensesin excess <strong>of</strong> 10 000 must also attachan Auditors<br />
<strong>Report</strong> All surplus funds after any refund to the candidate or his or her spouse shall be paid immediately over to the clerk who was<br />
responsible for the conduct <strong>of</strong> the<br />
election YYYY MM DD YYYY MM<br />
DD Fora campaign period from day candidate filed nomination a0 10 O a d to Q0 10 1 a<br />
3 Primary filing reflecting financesto December 31 or45 h day after voting day in aby<br />
election Supplementary filing including finances after December 31 or 45 h day after voting day in aby<br />
election Box A Name<strong>of</strong> Candidate and<br />
Office Name<strong>of</strong><br />
Candidate Last Name First Name Middle<br />
Initial<br />
FOOD Mailing<br />
Address Suite Unit No Street No Street<br />
Name 18 8 N<br />
tvZ <strong>City</strong><br />
Town Province Postal<br />
Code T cie7 egI Al ON FlK10<br />
1 Telephone No incl area code Fax No Email<br />
Address<br />
Business<br />
Home 9 aJq0 3 40 t p<br />
Logo ho<br />
Q Name<strong>of</strong> <strong>of</strong>fice for whichthe candidate sought election Ward Name or NoIf<br />
any ge C RasTL c Pc 51<br />
r Name<strong>of</strong><br />
Municipality 1iA<br />
W1 BoxB Summary <strong>of</strong> Campaign Incomeand<br />
Expenses 1 My spending limit as issued by clerk was 1 6X7 9<br />
30 2 Surplusor deficit from previous election<br />
Fs 3 Total contributions received from Schedule 1 s ILj<br />
9 4 My total campaign expenses that were subject to the spending limit were from Box C s 5 7 1<br />
g 5 My total campaign expenses that were not subject to the spending limit were from Box C s 680<br />
00 6 Total <strong>of</strong>all campaign expenses from Box C<br />
s<br />
7 Election campaign surplus deficit from current election from Box<br />
E Ise<br />
r8 Contributions refundedto candidateor spouse from Box EF gyp 0<br />
Q 9 Amount paid to clerk from Box E<br />
Is 9503P 2010101 Queens Printer for Ontario 2010 Disponible en fran ais Page 1 <strong>of</strong>
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate 0 0<br />
Contributions from spouse <strong>of</strong> candidate 1 o 00<br />
All other contributions 3 3<br />
Revenue from fund raising functions not deemed a contribution<br />
3d<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income Is 4 I 3<br />
C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures 16 28<br />
Interest on loan<br />
Inventory<br />
Meetings<br />
contributed to candidate s campaign Schedule 3<br />
hosted 00 150<br />
Nomination filing fee<br />
Office expenses<br />
D<br />
304 QD<br />
62<br />
Phone and or Internet 1941<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs 6 C70<br />
Other provide full details<br />
1 Op<br />
2<br />
3<br />
Subtotal is 3 Jc 11 CT<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
X80 0O<br />
Voting day party appreciation notices a 50 oo<br />
Expenses related to candidate s disability provide details<br />
1<br />
C2<br />
2<br />
3<br />
Other provide full details<br />
1 10 44<br />
2 60 nn<br />
3<br />
Subtotal 4<br />
C3<br />
Total Campaign Period Expenses C2 C3 2 5 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
z<br />
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Is<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong>Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part 1 Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
E1<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
E2<br />
Surplus or deficit for the campaign period E1 E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I 1 G 01 F0 9 p a candidate in the municipality <strong>of</strong><br />
1crr i 1 a hereby declare that to the best <strong>of</strong> 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 />
CA N OS tGKGt t<br />
on yyyy mm dd ap l1 C LI a1<br />
9503P 2010ro1<br />
V Cl<br />
Signature <strong>of</strong> Clerk or Commissioner Sig ure <strong>of</strong> Candidate<br />
aC1 1 b L4 l I el<br />
Date Filed in the Clerk s Office yyyy mm dl<br />
DEBBIE MSHIM CITY CLERK<br />
CITY OF PICKPING<br />
EX OFFICIO MISSIONER<br />
PURSUANT SECTION 12<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
r<br />
a<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
j<br />
Part I<br />
Contribution<br />
Contribution from candidate Q O<br />
Contribution from spouse 00 O<br />
Total from each single contributor totalling<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse 6 L5 00<br />
more than 100<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse Is 1 0 00<br />
Note Goods and services must also be reported as expenses<br />
in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 18<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
oE c 1 St1oRE v big io2ovia ov rn C 391 200<br />
E t W AB 200<br />
04 H v cAmj Et Ro<br />
d o TD Mir 3r P 540 0<br />
plgm 6DI W t 11Iftmg 1 rz ouA C965 ti Lis C 5 i 25 o d<br />
Additional information is listed on separate supplementary attachment Total l<br />
9503P 2010101<br />
Page 4 <strong>of</strong> 8
Ta ble 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
36 Bone cxcrt<br />
G3<br />
b6Ktl1 KKtS4 AX ON Uflutbol FvK w Isa<br />
15 1 CAN COe S<br />
5O oO<br />
nlsV f rAli AOA ON LIT 4k 3 ObBE Foo Troll Fuu WimSeR 13 OD<br />
KcNi 1 cK CINCE t 1 H DE v ZD 5 FAC rSODK gFr up RNA<br />
IDPW n 00 M1936u EAI AN CE 147 0 c70<br />
Additional information is listed on separate supplementary attachment Total g<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or<br />
activity<br />
held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admissioncharge per person may not exceed individual contribution limit<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold 26<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2121 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part 11 Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1 FFt rlllt AcK NfRunlc ioN 3 5<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Expenses Related to Fund Raising Function<br />
Venue<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C 80 0v<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Sche6ule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
YYYY mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
Y mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010101 Page 7 <strong>of</strong> 8
Y<br />
Auditor s <strong>Report</strong><br />
MunicipalEections Act 1906 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation<br />
<strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
No incl area code Fax No<br />
Email Address<br />
ext<br />
9503P 2010101 Page 8 <strong>of</strong> 8
I<br />
II<br />
I<br />
i<br />
IV<br />
Ministry <strong>of</strong> Municipal<br />
Ontario Affairs<br />
and Housing<br />
Notice <strong>of</strong> Extension <strong>of</strong> Campaign<br />
Period Form 6<br />
Municipal Elections Act 1996 Sections 68 82 1<br />
Instructions<br />
To be completed and filed with the clerk by candidates or registrants requesting an extension <strong>of</strong> the campaign period<br />
due to a deficit<br />
This notice must be filed on or before December 31 in the year <strong>of</strong> a regular election and 45 days after voting day in the<br />
case <strong>of</strong> aby election<br />
Name <strong>of</strong> Candidate and Office Registrant and Question<br />
Name <strong>of</strong> Candidate Registrant<br />
Last Name First Name Middle Initial<br />
xo<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
t Jfi<br />
lg 8 t vcoue7 b VF<br />
<strong>City</strong>fTown Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election or the Ward name or no if any<br />
question for which the registrant incurred expenses<br />
ICA 740ov 4 A00 CQ<br />
Name <strong>of</strong> Municipality<br />
Declaration<br />
and declare to the clerk that I have a deficit and wish the campaign period to be extended<br />
the candidate registrant mentioned above hereby give notice<br />
in accordance with section 68<br />
Declared before me<br />
at the<br />
C<br />
<strong>of</strong><br />
P i Gh2 r1 n o<br />
in the<br />
Ml2D t n<br />
<strong>of</strong><br />
Dw K cam<br />
Cjafnbe T 20<br />
this s day <strong>of</strong> ULP<br />
LO<br />
Signature <strong>of</strong> Clerk Signatu <strong>of</strong> Candidate Registrant<br />
Date<br />
10 O a <strong>of</strong> 0 f2 S6<br />
yyy mm dd Date yyy m dd<br />
10550P 2010101<br />
Queen s Printer for Ontario 2010<br />
Disponible en frangais
April 19 2011<br />
Further to the filing <strong>of</strong> an Extension <strong>of</strong> Campaign Period please<br />
be advised<br />
that I<br />
have completed my campaigning<br />
for the 2010 Elections and attached<br />
is my Supplementary Filing Form 4 which is the same as my Primary Filing<br />
Ida Fogo
Ministry <strong>of</strong> Municipal Affairs<br />
Ontario and Housing<br />
No t i C<br />
Financial Statement<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Auditor s <strong>Report</strong><br />
s i al o9 CC mpc g vt<br />
Instructions<br />
Per 1U0 CO t Pr t lill SLA PPI GUhc04 j<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as Ft 1<br />
vc<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong>p<br />
Pi Scnn tM0 ir<br />
r X5<br />
All surplus funds after any refund to the candidate or his or her spouse shall be paid immediately over to the clerk w o was res nsib<br />
for the conduct <strong>of</strong> the election<br />
For the campaign period from day candidate filed nomination<br />
YYYY MM DD YYYY MM<br />
1 1<br />
01Y Vg0t 1 O L4 I ccv<br />
imary filing reflecting finances to December 31 or45 day after voting day in a by election<br />
Vpplementary filing including finances after December 31 or 45h day after voting day in a by election<br />
Box A Name <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
Mailing Address<br />
roCo<br />
Suite Unit No Street No Street Name<br />
I<br />
to<br />
D<br />
<strong>City</strong> Town Province Postal Code<br />
c E9 1 Al D1V 119110 O<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
l Ago<br />
Ward Name or No tf any<br />
9c P 0 15 1 pusicc Pe nJ4T<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Name <strong>of</strong> Municipality<br />
uK1arv1<br />
Box B Summary <strong>of</strong> campaign Income and Expenses<br />
a a<br />
1 My spending limit as issued by clerk was 1 Yq 30<br />
2 Surplus or deficit from previous election<br />
3 Total contributions received from Schedule 1<br />
Is q 1 a<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
3 5 71 8 f<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C 680 0o<br />
6 Total <strong>of</strong> all campaign expenses from Box C t 5 g<br />
7 Election campaign surplus deficit from current election from Box E<br />
8 Contributions refunded to candidate or spouse from Box E I O o o 67<br />
9 Amount paid to clerk from Box E<br />
9503P 2010101<br />
Queen s Printer for Ontario 2010 Disponible<br />
en franpais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
100<br />
Contributions from spouse <strong>of</strong> candidate<br />
t0<br />
All other contributions 61 39<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III 375 6Q<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
j<br />
Inventory<br />
contributed to candidate s campaign Schedule 3<br />
Meetings hosted 1504<br />
Nomination filing fee 100<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs i78 0<br />
Other provide full details<br />
1 5o<br />
2 Q<br />
3<br />
Subtotal 3 J C5 1<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
80 Q0<br />
Voting day party appreciation notices 50 p0<br />
Expenses<br />
1<br />
2<br />
3<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1 t O0 00<br />
2 100<br />
3<br />
Subtotal 0<br />
C3<br />
Total Campaign Period Expenses C2<br />
C3<br />
Excess Deficiency <strong>of</strong> Income over Expenses C1<br />
C4<br />
AD<br />
C4<br />
9503P 2010101<br />
Page 2 <strong>of</strong> 8
Boz D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
2<br />
3<br />
Total Liabilities<br />
I<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
PartIDetermination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1 E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
Total Determination<br />
E1<br />
E2<br />
E3<br />
Part 11 Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I ck a G p<br />
a candidate in the municipality <strong>of</strong><br />
CVtr L Y1 c hereby declare that to the best <strong>of</strong> 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 mm dd O l Zo 1 19<br />
Signature <strong>of</strong> Clerk or Commissioner Sig ure <strong>of</strong> Candidate<br />
GC1 1<br />
G L4 n<br />
Date Filed in the Clerk s Office yyyy mm d1<br />
9503P 2010<br />
DEBBIE M SHI 1S CITY CLERK<br />
CITY OF PICKING<br />
EX OFFICIOOWMISSIONER<br />
PURSUANT it SECTION 10<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
wa<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate<br />
i 10C<br />
Contribution from spouse<br />
pQ Q Q<br />
Total from eachr single contributor totalling<br />
include all ticket revenue where ticket price exceeds 100<br />
more than 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
6 lac<br />
do not include contributions from candidate or spouse 0<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable<br />
to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling<br />
More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table<br />
Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business Manager<br />
Business As<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
r<br />
rfF ifr t tom f FJ G is f eJ iia J<br />
i 6t4 Al CiEF I rt t<br />
Kr<br />
OUj Z 57<br />
levtJ Q Jam fA Ifi<br />
r1lQ stJ AtANC<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
aq 0rp<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or<br />
activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
9C 2A<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 21B include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III<br />
Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C 375<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink 06<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
80 0v<br />
9503P 2010 101 Page 6 <strong>of</strong> 8
I<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Schedule 4<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
y mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation<br />
<strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010101 Page 8 <strong>of</strong> 8
i<br />
r<br />
tploontario<br />
and<br />
Ministry <strong>of</strong> Municipal Affairs<br />
Housing<br />
Financial Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
MM DD YYYY MM DD<br />
YYY<br />
For the campaign period froth day candidate filed nomination I O 0 1 to<br />
I 01A I I US L<br />
1017 07<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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial Q<br />
Q i t s PCJ I<br />
I<br />
Mailing Address<br />
Suite Unit No Street No Street<br />
V75 WekA tA Cres<br />
P C CAA L1 6Z<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
Ia<br />
S<br />
I<br />
90 IT eto LW 00T a<br />
Pqvjus C<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
Ward Name or No if any<br />
Name <strong>of</strong> Municipality<br />
Box B Summary <strong>of</strong> Campaign Income and Expense<br />
1 My spending limit as issued by clerk Was<br />
Is<br />
2 Surplus or deficit from previous election<br />
I<br />
3 Total contributions received from Schedule 1<br />
Is 106 11<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
I<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
Is<br />
10 0<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is<br />
8 Contributions refunded to candidate or spouse from Box E<br />
9 Amount paid to clerk from Box E<br />
Is U I<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
i<br />
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
b<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate i Q Q<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income i 0 L C1<br />
EXPENSES Note include the value <strong>of</strong> contributilons <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee 0 6<br />
Office expenses<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal OQ<br />
C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses<br />
Expenses<br />
Voting day party<br />
related to controverted elections<br />
related to recounts<br />
appreciation notices<br />
Expenses related to candidate s disability provide details<br />
1<br />
2<br />
3<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2 C3<br />
Excess Deficiency <strong>of</strong> Income over Expenses C4<br />
C4<br />
leW<br />
v C<br />
O<br />
C3<br />
C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
i<br />
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule a<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable 77777<br />
Borrowings overdraft<br />
Other provide full details<br />
j<br />
2<br />
3<br />
Total Liabilities<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplus or Deficit and Disposition <strong>of</strong> Surplus<br />
Part I Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period Ell E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or<br />
spouse only if there is a surplus<br />
Total Determination<br />
Ell<br />
E2<br />
E3<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I POO LA I Ct YN I S a candidate in the municipality <strong>of</strong><br />
prc 1<br />
hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attac ed supporting schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the<br />
C l p<br />
on<br />
yyyy mm dd oOl I O3 023<br />
Signature <strong>of</strong> Clerk or Commissioner Si94<br />
<strong>of</strong> Candidate<br />
adt i<br />
o3 a3<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
SA DIANNE HARKER<br />
Commissionereta Regional Municipality<br />
<strong>of</strong> Durham for The Corporation <strong>of</strong> the<br />
<strong>City</strong> <strong>of</strong> <strong>Pickering</strong><br />
xpires January 28 2012<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
i<br />
Schedule 1<br />
Contributions<br />
Part I<br />
Contribution<br />
Contribution from candidate<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or<br />
less<br />
include all ticket revenue where ticket price i 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
i 0<br />
Less<br />
Contribution returned or<br />
payable to the contributor<br />
Contribution paid or payable to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution 100<br />
Total contribution from anonymous sources<br />
1B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A 18<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from<br />
individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Is<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
I<br />
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
01<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is Jisted on separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
I<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong><br />
event or activity<br />
Admissioncharge per person may not exceed individual contribution limit<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold i<br />
12B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part II<br />
Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
2<br />
3<br />
4<br />
5<br />
6 j<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or lest revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
i<br />
I<br />
i<br />
Schedule 3 Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
ymm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Inventory <strong>of</strong> Campaign Goods and Materials At The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy nim dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
Is<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
i<br />
i<br />
I<br />
Auditor s <strong>Report</strong><br />
Municipal Elecfions Act 1996 Section 78<br />
A candidate who has received contributions or incutred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness<br />
ark d accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code<br />
ext<br />
Fax<br />
tVo<br />
Email Address<br />
i<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8
Ministry <strong>of</strong> Municipal Affairs<br />
r Ontario and Housing<br />
Financial Statement Auditor s <strong>Report</strong><br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong> 10 000 must also attach an Auditors <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination I<br />
01 01<br />
I I 07 I<br />
to<br />
110 I<br />
2<br />
13<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 <strong>of</strong> Candidate andAffice<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
1 c C A ti LYL 1 r t w<br />
I<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
X01<br />
LraS f3A K L A<br />
<strong>City</strong> Town Province Postal Code<br />
PlCi LILtjG OP142I0 IU 3C9<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
Home<br />
q05 93 r1 YSy 4mcCA CCL a @A0 12s<br />
<strong>of</strong> <strong>of</strong>fice for which the candidate sought election Ward Name or Noif anyj<br />
U L N C h fwoct<br />
<strong>of</strong> Municipality tCKet<br />
NG Box<br />
C IS7rtt C7 Sc ttaOr4R 7fSLL Name<br />
B Summary<strong>of</strong> Campaign Income and Expenses1<br />
car Name<br />
My spending limit as issued by clerk wasj 1 7 2<br />
Surplus or deficit from previous electionIs<br />
0 1 3<br />
Total contributions received from Schedule1j 5 S5 i<br />
4<br />
My total campaign expenses that were subjectto the spending limit were from Box Cl 1 c 3 5<br />
My total campaign expenses that were not subjectto the spending limit were from Box C Is<br />
a<br />
6<br />
Total <strong>of</strong> all campaign expenses from Box C 3 s 7<br />
Election<br />
campaign surplus deficit from current election from Box E I<br />
8<br />
Contributions refundedto candidateor spouse from Box E 9<br />
Amount paid to clerk from Box E Is<br />
9503P<br />
20101010 QueensPrinter for Ontario 2010 Disponible en frangais Page 1 <strong>of</strong> 8
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM DD YYYY MM DD<br />
290 ear o7 2010 1 31 Mc C A r ri<br />
r<br />
INCOME<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign Period Income<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Is9193 5q C1<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
7 9 05<br />
Interest on loan<br />
Inventory contributed to candidate s campaign Schedule 3<br />
Meetings hosted<br />
Nomination filing fee D bt<br />
Office expenses 4469 37<br />
Phone and or Internet<br />
17 3<br />
Salaries and benefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
D 5y<br />
Subtotal 1 3 9 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting<br />
and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
appreciation notices<br />
related to candidate s disability provide details<br />
3<br />
I<br />
Other provide full details<br />
1<br />
2<br />
3<br />
i<br />
Subtotal<br />
C3<br />
Total Campaign Period Expenses C2 C3 q 3 C4<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained from Schedule 4 Y S g<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Assets i f JB f<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
Box E State ment <strong>of</strong> Determination <strong>of</strong> Surp us or Defioitand Dispo qition <strong>of</strong>Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Is<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction CPS E2<br />
Surplus or deficit for the campaign period E1<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus<br />
E2<br />
E1<br />
Total Determination<br />
E3<br />
Part II Disposition <strong>of</strong> Surplus<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
Box F Declaration<br />
I J I n M C CAr1C L 1 y a candidate in the municipality <strong>of</strong><br />
P I C IL C a I rJ G hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements and attached supporting schedules are true and correct<br />
Declared before clerk or commissio ner<br />
in the<br />
Ciu N CI eJla<br />
on<br />
yyyy mm dd Z1 43 3<br />
cydG TI<br />
Signature <strong>of</strong> Clerk or Commissioner<br />
Signature<br />
aoI 1 63 Q3<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
J<br />
<strong>of</strong> Candidate<br />
USA DIANNE HMKER<br />
Commaissiomeeetu Reglomal Munidpal dy<br />
<strong>of</strong> Durham forThe Corporation <strong>of</strong> the<br />
city <strong>of</strong> Pidwring<br />
Cxpires January28 2012<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Y<br />
i<br />
Schedule 1<br />
Contribution s<br />
Part 1 Contribution<br />
Contribution from candidate 3 9<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less Contribution returned or payable to the contributor ill 1 5q<br />
Contribution paid or payable to the clerk<br />
Is<br />
Is<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1 B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1 B<br />
Part II List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Table 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on<br />
separate supplementary attachment<br />
Total<br />
Total Part II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
held is are listed on separate supplementary attachment s<br />
Admission charge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold<br />
2B<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 2B include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Is<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part III Revenue include in Box C<br />
Is<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> 8
Schedule 3<br />
Inventory <strong>of</strong> Campa gnGoodsand MaterJals from Previous Campaign<br />
Used inZandidate Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4 Jnventory<strong>of</strong> Caa gn Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
SI wS SVnALL AI011DII 1 ek Yn<br />
S 05 C SI LL aoi<br />
S1G<br />
4LvnA6G r 67 07 Sb<br />
lla<br />
cRr 1nA S Pn oe<br />
n 0710 C 5 3Y 537 S fl<br />
c wN Rs PDf<br />
u5Cucl5 olo o 3 c fJ 2 5i9 V I<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8<br />
W
Auditor s<strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
No incl area code Fax No<br />
Email Address<br />
ext<br />
9503P 2010<br />
Paqe 8 <strong>of</strong> 8
Ministry <strong>of</strong> Municipal Affairs Financial Statement Auditor s<br />
Ontario<br />
<strong>Report</strong><br />
and Housing<br />
Form 4<br />
Municipal Elections Act 1996 Section 78<br />
Instructions<br />
All candidates must complete Boxes A B C D E and F and Schedule 1 All candidates must complete Schedules 2 3 and 4 as<br />
appropriate Candidates who receive contributions or incur expenses in excess <strong>of</strong>10 000 must also attach an Auditor s <strong>Report</strong><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 <strong>of</strong> the election<br />
YYYY MM DD YYYY MM DD<br />
For the campaign period from day candidate filed nomination 06 to<br />
o<br />
Primary filing reflecting finances to December 31 or 45h 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 <strong>of</strong> Candidate and Office<br />
Name <strong>of</strong> Candidate<br />
Last Name First Name Middle Initial<br />
4 13 0L AYE<br />
Mailing Address<br />
Suite Unit No Street No Street Name<br />
WEE C i i Ir lz<br />
<strong>City</strong> Town<br />
Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
Business<br />
me<br />
y<br />
Name <strong>of</strong> <strong>of</strong>fice for which the candidate sought election<br />
8 J1SJ<br />
Ward Name or No if any<br />
1io L ShUI d Z L rzU<br />
Name <strong>of</strong> Municipality<br />
Box B Summary <strong>of</strong> Campaign Income and Expenses<br />
1 My spending limit as issued by clerk was o<br />
2 Surplus or deficit from previous election<br />
Is<br />
3 Total contributions received from Schedule 1 oc<br />
4 My total campaign expenses that were subject to the spending limit were from Box C<br />
Is 50<br />
5 My total campaign expenses that were not subject to the spending limit were from Box C<br />
Is<br />
6 Total <strong>of</strong> all campaign expenses from Box C<br />
4Z<br />
7 Election campaign surplus deficit from current election from Box E<br />
Is Vy nb<br />
8 Contributions refunded to candidate or spouse from Box E 7<br />
9 Amount paid to clerk from Box E<br />
Is 0 1<br />
9503P 2010<br />
Queen s Printer for Ontario 2010 Disponible en franpais Page 1 <strong>of</strong> 6
Box C Statement <strong>of</strong> Campaign Period Income and Expenses<br />
From To For Candidate<br />
YYYY MM D<br />
MM DD<br />
INCOME<br />
12YYYY<br />
D b to JAJ S V1<br />
Candidate s surplus from immediately preceding election released by the clerk<br />
Contributions from candidate<br />
10 73 50<br />
Contributions from spouse <strong>of</strong> candidate<br />
All other contributions 006<br />
Revenue from fund raising functions not deemed a contribution<br />
from Schedule 2 Part III<br />
Interest income<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Campaign<br />
Period Income 0 C1<br />
EXPENSES Note include the value <strong>of</strong> contributions <strong>of</strong> goods and services<br />
Expenses Subject to Spending Limit<br />
Advertising<br />
Bank charges<br />
Brochures<br />
Interest on loan<br />
dc7<br />
OD<br />
Inventory<br />
Meetings hosted<br />
contributed to candidate s campaign Schedule 3<br />
Nomination filing fee too 061<br />
Office expenses 2<br />
Phone and or Internet<br />
Salaries andbenefits honoraria<br />
pr<strong>of</strong>essional fees<br />
Signs<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal 0 C2<br />
Expenses Not Subject to Spending Limit<br />
Accounting and audit<br />
Costs <strong>of</strong>fund raising function from Schedule 2 Part IV<br />
Expenses related to compliance audit<br />
Expenses related to controverted elections 01<br />
Expenses related to recounts<br />
Voting day party<br />
Expenses<br />
1<br />
2<br />
3<br />
appreciation notices<br />
related to candidate s disability provide details<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Subtotal<br />
Total Campaign Period Expenses C2 C3<br />
D<br />
Excess Deficiency <strong>of</strong> Income over Expenses Cl C4 SY 4Q<br />
C3<br />
C4<br />
9503P 2010<br />
Page 2 <strong>of</strong> 8
Box D Statement <strong>of</strong> Assets and Liabilities as at 20<br />
Assets<br />
Cash<br />
Accounts receivable<br />
Value <strong>of</strong> inventory retained<br />
Other provide full details<br />
from Schedule a<br />
1<br />
2<br />
3<br />
Total Assets<br />
Liabilities and Excess Deficiency <strong>of</strong> Income over Expenses<br />
Accounts payable<br />
Borrowings overdraft<br />
Other provide full details<br />
1<br />
2<br />
3<br />
Total Liabilities<br />
f<br />
Box E Statement <strong>of</strong> Determination <strong>of</strong> Surplusor Defidit and Disposition <strong>of</strong> Surplus<br />
Part I<br />
Determination <strong>of</strong> Surplus or Deficit<br />
Amount <strong>of</strong> excess deficiency <strong>of</strong> income over expenses from Box C C<br />
Deduct Any deficit carried forward by the candidate from immediately preceding election<br />
if the <strong>of</strong>fices are with respect to the same jurisdiction<br />
Surplus or deficit for the campaign period E1<br />
E2<br />
Deduct Any refund <strong>of</strong> contributions to the candidate or spouse only if there is a surplus D 1 66<br />
Total Determination<br />
Part II<br />
Disposition <strong>of</strong> Surplus<br />
Qa E1<br />
If line E3 shows a surplus the amount must be paid in trust at the time the financial statements are filed to the municipal clerk who was<br />
responsible for the conduct <strong>of</strong> the election<br />
Surplus paid to the municipal clerk <strong>of</strong> the municipality <strong>of</strong><br />
BoxF Declaration<br />
E2<br />
E3<br />
Nt7 <strong>of</strong> a candidate in the municipality <strong>of</strong><br />
CJf u i hereby declare that to the best <strong>of</strong> my knowledge and belief that these<br />
financial statements<br />
d attached supporting<br />
schedules are true and correct<br />
Declared before clerk or commissioner<br />
in the 1 A cam t<br />
lC<br />
on yyyy mm dd O l C7 1 d C L<br />
Signature <strong>of</strong> Clerk or Commissioner Signature<br />
n idat<br />
901l 0a<br />
Date Filed in the Clerk s Office yyyy mm dd<br />
DEBBIE M SHIELDS CITY CLERK<br />
CITY OF PICKERING<br />
EX OFFICIO COMMISSIONER<br />
PURSUANT TO SECTION 1121<br />
OF THE COMMISSIONERS FOR<br />
TAKING AFFIDAVITS ACT<br />
9503P 2010<br />
Page 3 <strong>of</strong> 8
Schedule 1<br />
Contributions<br />
Part I Contribution<br />
Contribution from candidate f 0 7 YO<br />
Contribution from spouse<br />
Total from each single contributor totalling more than 100<br />
include all ticket revenue where ticket price exceeds 100<br />
include all goods and services where value exceeds 100<br />
do not include contributions from candidate or spouse<br />
Total from each single contributor totalling 100 or less<br />
include all ticket revenue where ticket price is 100 or less<br />
include all goods and services where value is 100 or less<br />
do not include contributions from candidate or spouse<br />
Note Goods and services must also be reported as expenses in Box C<br />
Less<br />
Contribution returned or payable to the contributor<br />
Contribution paid or payable<br />
to the clerk<br />
1A<br />
Total Amount <strong>of</strong> Contribution<br />
Total contribution from anonymous sources<br />
1B<br />
Amount <strong>of</strong> contributions paid or payable to the clerk 1A<br />
1B<br />
Part If List <strong>of</strong> Contributions from Each Single Contributor Totalling More than 100<br />
Table 1 Monetary contributions from individuals other than candidate or spouse<br />
Name Address Amount<br />
1 vs Iuv e w 3 i 5UIle zo ktjVJ k YOe<br />
Cls S l v l 17ZSh<br />
Additional information is listed on separate supplementary attachment Total 6 c<br />
9503P 2010<br />
Page 4 <strong>of</strong> 8
Tabie 2 Monetary contributions from unions or corporations<br />
Name Legal and Carrying on Address President or Cheque Signatory Amount<br />
Business As<br />
Business Manager<br />
Additional information is listed on<br />
separate supplementary attachment<br />
Total<br />
Table 3 Contributions in goods or services Note must also be reported as expenses in Box C<br />
Name Address Goods or Services Amount<br />
Additional information is listed on separate supplementary attachment<br />
Total<br />
Total Pan II Contributions<br />
9503P 2010<br />
Page 5 <strong>of</strong> 8
Schedule 2<br />
Fund Raising Function<br />
Additional schedule for each event or activity held is are listed on separate supplementary attachment s<br />
Date<br />
YYYY MM DD<br />
Description <strong>of</strong> event or activity<br />
Admissioncharge per person may not exceed individual contribution limit Is<br />
2A<br />
If admission charge per person is not consistent attach complete breakdown <strong>of</strong> all ticket sales<br />
Number <strong>of</strong> tickets sold 213<br />
Part I<br />
Ticket Revenue<br />
Lines 2A x 213 include in Schedule 1<br />
Part II Other Revenue Deemed A Contribution<br />
Provide full detailseg revenue from goods sold in excess <strong>of</strong> fair market value<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part II Revenue include in Schedule 1<br />
Part III Other Revenue Not Deemed A Contribution<br />
Provide full detailseg contributions <strong>of</strong> 10 or less revenue from refreshment sold at cost<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part Ill Revenue include in Box C<br />
Part IV<br />
Venue<br />
Expenses Related to Fund Raising Function<br />
Event advertising<br />
Food and drink<br />
Entertainment<br />
Other provide full details<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
Total Part IV Expenses include in Box C<br />
9503P 2010<br />
Page 6 <strong>of</strong> B
i<br />
I<br />
i<br />
Schedule 3<br />
Inventory <strong>of</strong> Campaign Goods and Materials from Previous Campaign<br />
Used in Candidate s Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
yyyy mm dd<br />
Total Value <strong>of</strong> Inventory from Previous Campaign<br />
Used in Candidate s Campaign<br />
Schedule 4<br />
Inventory <strong>of</strong> Campaign Goods and Materials at The End <strong>of</strong> Campaign<br />
Description Date Acquired Supplier Unit Value Quantity Total Value<br />
mm dd<br />
Total Value <strong>of</strong> Inventory <strong>of</strong> Campaign Goods and Materials<br />
9503P 2010<br />
Page 7 <strong>of</strong> 8
Auditor s <strong>Report</strong><br />
Municipal Elections Act 1996 Section 78<br />
A candidate who has received contributions or incurred expenses in excess <strong>of</strong>10 000 must attach an auditor s report The report<br />
must be done in accordance with generally accepted auditing standards and must<br />
set out the scope <strong>of</strong> the examination<br />
provide an opinion as to the completeness and accuracy <strong>of</strong> the financial statement and whether it is free <strong>of</strong> material misstatement<br />
Pr<strong>of</strong>essional Designation <strong>of</strong> Auditor<br />
Municipality<br />
Date yyyy mm dd<br />
Contact Person<br />
Last Name<br />
First Name<br />
Licence No<br />
Address<br />
Suite Unit No Street No Street Name<br />
<strong>City</strong> Town Province Postal Code<br />
Telephone No incl area code Fax No Email Address<br />
ext<br />
9503P 2010<br />
Page 8 <strong>of</strong> 8