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2006 Financial Statements - City of Pickering

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deunitnoC3fo2egaP<br />

FORM 4 Continued<br />

BOX C<br />

CONTRIBUTIONS MORE THAN 100 see attached list<br />

---Total <strong>of</strong>all contributions totalling more than lOO/contributor 3 5 -00<br />

BOX D CONTRIBUTIONS LESS THAN OR EQUAL<br />

TO 100<br />

Total <strong>of</strong> all contributions totalling 100 or less than lOO/contributor346 00 BOX<br />

E DECLARATIONI<br />

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

the <strong>of</strong>fice <strong>of</strong> 4 en / LLeY<br />

campaign period<br />

the above<br />

a the contributions received by me did not exceed 10 000 and expenses incurred by<br />

exceed<br />

10 000 and<br />

me did not<br />

b my surplus deficit under section 79 <strong>of</strong> the Municipal Elections Act 1996 was 5 8<br />

c the amount <strong>of</strong> surplus refunded to myself my spouse or same-sex partner<br />

under subsection 796 <strong>of</strong><br />

the Municipal Elections Act1996 was HSIw<br />

8 Declared<br />

before me at<br />

the c<br />

<strong>of</strong><br />

in the<br />

P c r -iY-<br />

5<br />

this<br />

b 20<br />

RCf tP Of Q Irh<br />

Vl<br />

- day <strong>of</strong> 1<br />

0<br />

/---dt signature <strong>of</strong>the clerk n L97<br />

or commissioner etc l -S<br />

signature <strong>of</strong> candidate date filed in the<br />

clerk s <strong>of</strong>fice -9503P 2003/07

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