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2006 Financial Statements - City of Pickering

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deunitnoC3102<br />

FORM 4 Continued<br />

BOX C CONTRIBUTIONS MORE THAN 100 see attached list<br />

-Total<strong>of</strong>all contributions totalling more than 100/contributor 3 IL 1c<br />

BOX D CONTRIBUTIONS LESS THAN OR EQUAL TO 100<br />

Total <strong>of</strong> all contributions totalling 100 or less than 100/contributorS 3 bO DC I<br />

BOX<br />

E DECLARATIONI<br />

the undersigneda candidateinthe municipality <strong>of</strong> lueot 1 for<br />

/ the <strong>of</strong>fice <strong>of</strong> ee 1 1/1 1- L jUC I-t bt -oJ /l Lt herebydeclare that during the above campaign period<br />

athe<br />

contributions receivedbyme did not exceed 10000 and expenses incurred by me did<br />

not exceed 10<br />

000 and b my<br />

surplus deficit under section 79<strong>of</strong> the Municipal Elections Act 1996 H wasII the<br />

c<br />

amount <strong>of</strong> surplus refunded to myself my sp y e or same-sex partner under subsection 79 6<strong>of</strong> the Municipal<br />

Elections Act 1996 wasjtf Declared before me<br />

C-I-fat<br />

/<br />

Rc<br />

o<br />

the -<br />

le ln <strong>of</strong><br />

I Dv<br />

the iO nOf IL this in<br />

day <strong>of</strong> Ap tl I 200<br />

i<br />

/<br />

/ JCQy<br />

uv<br />

uu signature <strong>of</strong>t he clerkor commissioner i5BIA ifmf Effi<br />

J t 1 1 9-elT OFPICKER<br />

l<br />

GIEX FFICIO<br />

COMM SSIONEH date filedin the clerk s <strong>of</strong>fice PUR UANTTO SECTION<br />

1<br />

2IOF THE<br />

COMMISSIONERSFOR TAKING<br />

AFFIDAVITS ACT --- 9503P 2003/07 Page

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