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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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kUd<br />

tland<br />

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 />

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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

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