2006 Financial Statements - City of Pickering

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FORM 4 Continued
BOX C CONTRIBUTIONS MORE THAN 100 see attached list
rotal 0 11
ntribotio totalling more tbm IOO/contributo-
J 5
-
I-BOXD CONTRIBUTIONS LESS THAN OR EQUAL
TO 100 Totalofall contributions totalling 100 or less than
100/contributor BOXE
DECLARATIONI the undersigneda candidate in the municipality
of firthe officeof go
Scl4i
d fvU
sfv campaign
period vv-f
OvVo-t hereby
declarc that during the above a
the contributions receivedby me did not exceed10 000 and expenses incurredby me
10 000 and b
did not exceed
my surplus deficit under section 79of the Municipal Elections Act 1996 was IUl c
the amountof surplus refunded to myself my spouseor same-sex partner under subsection 796of the
Municipal Elections Act 1996 was f1 Declared before
the
of
U
--j
in
the
YA of
this
1
o
b
signature
day
oLD 20
r DEBBIE M
SHIELDS DEPUTY CLERKICITY OF
OFFICIO
PICKERINGgIEX
COM MISSIONER PURSUANTTO
meCat
SECTION 12 OF THE
COMMISSIONERS FORTAKING AFFIDAVITS
ACTI-
of theclerk or commissioneretc Dec
1 1 Ok date
l
/ t
l signature of
C
filedinthe clerks office 9503P
2003/07 ITlOI
candicl - Page 2