2006 Financial Statements - City of Pickering

FORM 4 Continued
BOX C CONTRIBUTIONS MORE THAN 100 see attached list
-Total ofall contributions totalling more than SIOO/contributor
A/
Cj
BOX D CONTRIBUTIONS LESS THAN OR EQUAL
TO 100
tal of 11 b oo Iotal 100 I th JOO/ bolo
ct
l
BOX E
DECLARATION
the undersigned a candidate in the municipality of
for the office of Sc oo ou-dlr-IAJ -tt- hereby declare
perioda
p c tt n
that durie above campaign
the contributions receivedby me did not exceed10 000 and expenses i ncuredby me
10 000 and b
r l of D
J
r d
did not exceed
my
surplus deficit under section79of the Municipal Elections Act1996 was7 8 7c
the amountof surplus refunded to myself my spouseor same-sex partner under subsection 796of the
Municipal Elections Act 1996 was 8 Declared before
meat the
C
d
of P
c
c r in the
Kc6
1of t of O
this day
u
of f0A h 20 D
7 D signature
of
the clerkor commissioner etc signature of candidate ffiot
ch 2
3 / 0 7 date
filedin the clerks office DEBBIE
MSHIELDS DEPUTY CLERK CITY
Of PICKERINGEX
OFFICIO COMMISSIONER PURSUANT
TO SECTION12 OF
THE COMMISSIONERSFORTAKING
f FFIOAVITSACT-
9503P 2003/07 Page 2013 Continued