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2006 Financial Statements - City of Pickering

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FORM 4 Continued<br />

BOX C CONTRIBUTIONS MORE THAN 100 see<br />

attached list<br />

Total <strong>of</strong>all contributions totalling more than 1 OO/contributor4<br />

0 1 0 BOX<br />

D CONTRIBUTIONS LESSTHAN OR EQUAL TO 100 Total<br />

<strong>of</strong> all contributions totalling more than 100 or less than 100/contributor<br />

Ibl<br />

n<br />

oo BOX E<br />

DECLARATIONIthe<br />

undersigned a candidate inthe municipality <strong>of</strong> P C ItJb for the<br />

<strong>of</strong>fice <strong>of</strong> 6CL TRJ pSB<br />

during<br />

above campaign period hereby declare<br />

the<br />

thatathe<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 ElectionsAct 1996 was c the<br />

amount <strong>of</strong>surplus refundedto myself my spouse or same-sex partner under subsection796<strong>of</strong>the Municipal<br />

Elections Act 1996 was Declared before me<br />

Atthe C<br />

<strong>of</strong>i C<br />

JLetire In the<br />

L<br />

cy <strong>of</strong> r-hQ rn This at day<strong>of</strong><br />

t10reh t1QrO 1 Cl date<br />

in<br />

filed<br />

the<br />

clerks <strong>of</strong>fice C9vub signature <strong>of</strong> candidate<br />

9S03P<br />

2003/07 Pa e20fJ

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