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2006 Financial Statements - City of Pickering

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deunitnoC3<br />

FORM 4 Continued<br />

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

-Total <strong>of</strong>all contributions totalling more than IOO/contributor 0 010 G<br />

BOX D CONTRIBUTIONS LESS THAN OR EQUAL<br />

TO 100<br />

Total <strong>of</strong> all contributions totalling 100 or less than IOO/contributor/ a<br />

7<br />

BOX E DECLARATION<br />

I the undersigned a candidate in the municipality <strong>of</strong><br />

for the <strong>of</strong>fice <strong>of</strong> c It l<br />

LOIl h lI Jtwl L<br />

campaign period<br />

PI I trt 10 Li<br />

hereby declare tftaturing the above<br />

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

me did not<br />

exceed 0 000 and<br />

b<br />

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

c the amount <strong>of</strong> surplus refunded to myself my spouse or same-sex partner under subsection796 <strong>of</strong><br />

the Municipal Elections<br />

Act1996 was Declared<br />

before me at<br />

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

Pl 8 in<br />

the Qi 9 1<strong>of</strong> exr - c n<br />

this I day <strong>of</strong> 9<br />

20 01<br />

- bC<br />

candidate signature <strong>of</strong> the clerkor commissioner<br />

etc<br />

H9 ro<br />

f signature<strong>of</strong><br />

7 date filed inthe clerk s<br />

<strong>of</strong>fice-9503P 2003/07<br />

Page 2 <strong>of</strong>

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