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2006 Financial Statements - City of Pickering

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OlJ<br />

00 00 00 00 00 00 c J eh<br />

in<br />

the 00<br />

before<br />

me<br />

00 ig<br />

FORM 4 Continued<br />

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

Total <strong>of</strong> all contributions totalling more than lOO/contributor1- s1<br />

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

- ---rr<br />

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

E DECLARATIONI<br />

the undersignega andidate inth unicipality<br />

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

the <strong>of</strong>fice<strong>of</strong>f<br />

131<br />

IV L/tG IC D Art ilIAS -r campaign<br />

period<br />

ct<br />

f- t 0C hereby<br />

declare<br />

that duringthe aboveathe<br />

contributions receivedbyme did not exceed 10 000 and expenses incurred by me did<br />

not exceed 10<br />

000 andb my<br />

surplus deficit under section 79<strong>of</strong> the Municipal ElectionsAct1996 was c the<br />

amount <strong>of</strong> surplus refunded tomyself my spouse or same-sex partner under subsection79 6<strong>of</strong> the Municipal<br />

Elections Act 1996 was 00 00 00 00 00 Declared<br />

Ctu at<br />

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the 00<br />

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oo<strong>of</strong> 00 O<br />

Ih this day <strong>of</strong><br />

f /jY<br />

k 20 7 ----<br />

date<br />

61-<br />

V<br />

filed<br />

4dsignature<br />

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oo<br />

<strong>of</strong> the clerk Oi etc RP<br />

/t 80P 1<br />

mtme<strong>of</strong>e dida v<br />

inthe clerks <strong>of</strong>fice ojeAf<br />

-9503P 2003/07 Page 2 <strong>of</strong> 3 Continued

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