CAMPAIGN FINANCE STATEMENT - Al Itwar - 20221024.pdfMinistry of Municipal Affairs Financial Statement -Ontario(i and Housing
Auditor's Report Candidate -Form 4
Municipal Elections Act, 1996 (Section 88.25)
Instructions
All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses must complete
Boxes C, D, Schedule 1 and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in
excess of$10,000 must also attach an Auditor's Report.
All surplus funds (after any refund to the candidate or their spouse) shall be immediately paid to the clerk who is responsible
for the conduct of the election.
yyyy MM DD YYYY MM DD
For the campaign period from (day clerk received nomination) j '/;<:•1fL I o~ I It I to I.___'--''----'
~ Initial filing reflecting financ~s from start of campaign to December 31 (or 45 days after voting day in a by-elaction)
D Supplementary filing reflecting finances from start of campaign to end of extended campaign peMod
Box A: Name of Candidate and Office
Candidate's name as shown on the ballot
Last Name or Single Name -r.-r w Pill-
Office for Which the Candidate Sought Election
'1Jl u.li-.oliL-r-, 4-S<.Mot ~ 1~
Spending Limit
Given Name(s)
/\L
Ward Name or Number
~
(if any)
A,;,-""' U"'
Contribution Limit
Parties and Other Expressions of Appreciation Gen11ral '!> Contributions from Candidate and Spouse
$ !'t / ?51/7. ;_.... $ JC\U. :J. s 33'7 !!.-
D I did not accept any contributions or incur any expenses. (Complete Boxes A and B only)
Box B: Declaration
belief that these financial statements and attached supporting schedules are true and correct.
"' Signature of Candidate
Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (if filed in person) Designate
9503P (2022/04) e Queen's Printer for Ontario, 2022 Dlsponlble en fra~is Page 1 of7
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Box C: Statement of Campaign Income and Expenses
LOAN
Name of bank or recognized lending institution Amount borrowed
$ 0
INCOME
Total amount of all contributions (from line 1A in Schedule 1) + $ ~ 33"1 11
Revenue from items $25 or less + $ t7/B
Sign deposit refund + $ ,J/,.q
I Revenue from fundraising events not deemed a contribution
{from Part Ill of Schedule 2) + $ µt
Interest earned by campaign bank account + $ ~ other (provide full details)
1. + $
2. + $
3. + $
4. + $
5. + $
6.
Total Campaign Income (Do not include loan)
+ $
= $ $/If j'.) '; 3 7 ~ C1
)
EXPENSES (Note: Include the value of contributions of goods and services)
1. Expenses subject to general spending limit
Inventory from previous campaign used in this campaign
{list details in Table 2 of Schedule 1)
Advertising
+ $
+ $
('.)
ISi ,~
Brochures/flyers + $ 13(,. '0-
Signs (including sign deposit) + $ 0
Meetings hosted + $ 0
Office expenses incurred until voting day + $ 0
Phone and/or internet expenses incurred until voting day + $
Salaries, benefits, honoraria, professional fees incurred until voting day + $ 0
Bank charges incurred until voting day + $ 0
Interest charged on loan until voting day + $ ()
Other (provide full details)
1. + $
2. + $
3. + $
4. + $
5. + $
6. + $
Total Expenses subject to general spending limit = $ ~3,. :,\ C2
2. Expenses subject to spending limit for parties and other expressions of appreciation
1. + $
9503P (2022/04) Page 2 of 7
\;
2. + $
3. + $
4. + $
5. + $
Total Expenses subject to spending limit for parties and other
expressions of appreciation = $ 0 C3
3. Expenses not subject to spending limits
Accounting and audit + $
Cost of fund raising events/activities (list details in Part IV of Schedule 2) + $
Office expenses incurred after voting day + $
Phone and/or internet expenses incurred after voting day + $
Salaries, benefits, honoraria, professional fees incurred after voting day + $
Bank charges incurred after voting day + $
Interest charged on loan after voting day + $
Expenses related to recount + $
Expenses related to controverted election + $
Expenses related to compliance audit + $
Expenses related to candidate's disability (provide full details)
1. + $
2. + $
3. + $
4. + $
5. + $
Other (provide full details)
1. + $
2. + $
3. + $
4. + $
5. + $
Total Expenses not subject to spending limits = $ C4
Total Campaign Expenses (C2 + C3 + C4) = $ 7:,'?,7. ~ cs
Box D: Calculation of Surplus or Deficit
Excess ( deficiency) of income over expenses 0
(Income minus Total Expenses) (C1 -C5) + $ ~ D1
If there is a surplus, deduct any refund of candidate's or spouse's
contributions to the campaign - $ 0
Surplus (or deficit) for the campaign = $ 0 D2
If line D2 shows a surplus, the amount must be paid in trust, at the time the financial statements are filed, to the municipal clerk
who is responsible for the conduct of the election.
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Schedule 1 -Contributions
Part I -Summary of Contributions
Contributions in money from candidate and spouse + $ ?,31 3..!..
Contributions in goods and services from candidate and spouse
(include value listed in Table 1 and Table 2) + $ ()
Total value of contributions not exceeding $100 per contributor
Include ticket revenue, contributions in money, goods and services
where the total contribution from a contributor is $100 or less
(do not include contributions from candidate or spouse). + $ --------
Total value of contributions exceeding $100 per contributor
(from line 1 B; list details in Table 3 and Table 4)
Include ticket revenue, contributions in money, goods and services
where the total contribution from a contributor exceeds $100
(do not include contributions from candidate or spouse). + $ 0
Less: Ineligible contributions paid or payable to the contributor - $
0
Contributions paid or payable to the clerk, including contributions
from anonymous sources exceeding $25
Total Amount of Contributions (record under Income in Box C)
- $
= $
0
)37 3l 1A
Part II -Contributions from candidate or spouse
Table 1: Contributions in goods or services
Description of Goods or Services Date Received
(yyyy/mm/dd)
Value($)
Total
'
0
D Additional information is listed on separate supplementary attachment, if completed manually.
Table 2: Inventory of campaign goods and materials from previous municipal campaign used in this campaign
(Note: Value must be recorded as a contribution from the candidate and as an expense.)
Current Market Quantity Date Acquired Supplier Description
Value($) (yyyy/mm/dd)
Total 0
D Additional information is listed on separate supplementary attachment, if completed manually.
Part Ill -Contributions exceeding $100 per contributor -individuals other than candidate or spouse
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Table 3: Monetary contributions from individuals other than candidate or spouse
Name Full Address Date Received Amount
(yyyy/mm/dd) Received ($)
Total ()
Amount Returned
to Contributor or
Paid to Clerk ($)
D Additional information is listed on separate supplementary attachment, if completed manually.
Table 4: Contributions in goods or services from individuals other than candidate or spouse
(Note: Must also be recorded as Expenses in Box C.)
$ __ 0 ___ 18
Page5of7
Name Full Address Description of Goods Date Received
or Services (yyyy/mm/dd)
Total
D Additional information is listed on separate supplementary attachment, if completed manually.
Total for Part Ill -Contributions exceeding $100 per contributor
(Add totals from Table 3 and Table 4 and record the total in Part 1 -Summary of Contributions)
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Value($)
0
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-------
-------
-------
-------------------------------
-------
-------
-------
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Schedule 2 -Fundraising Events and Activities
Complete a separate schedule for each event or activity held. D Additional schedule(s) attached, if completed manually .
. Fundraising Event/Activity 1 N \/
Description of fundraising event/activity rv A ----'--7.f-L_J_ ____________________ _
Date of event/activity (yyyy/mm/dd)
Part I -Ticket revenue
Admission charge (per person) __:$:__ ______ 2A
(If there are a range of ticket prices, attach complete breakdown of all ticket sales)
Number of tickets sold x _______ .28
Total Part I (2A X 28) (include in Part I of Schedule 1) =$
Part II -Other revenue deemed a contribution
Provide details (e.g., revenue from goods sold in excess of fair market value)
1. + $
2. +$ ----'---------
3. +$
4. +$
5. + $
Total Part II (include in Part I of Schedule 1) = $
Part Ill -Other revenue not deemed a contribution
Provide details (e.g., contribution of $25 or less; goods or services sold for $25 or less)
1. + $
2. +$
3. +$
4. +$
5. + $
=$ Total Part Ill (include under Income in Box C)
Part IV -Expenses related to fundraising event or activity
Provide details
1. + $
2. + $
3. + $
4. +$ ----'---------
5. + $
Total Part IV Expenses (include under Expenses In Box C) = $
Page6of7 9503P (2022/04)
Auditor's Report-Municipal Elections Act, 1996 (Section 88.25)
A candidate who has received contributions or incurred expenses in excess of $10,000 must attach an auditor's report.
Professional Designation of Auditor
Municipality Date (yyyy/mm/dd)
Contact Information
Last Name or Single Name Given Name(s) Licence Number
Address
Suite/Unit Number I Street Number I Street Name
Municipality
Telephone Number Email Address
Province I Postal Code
The report must be done in accordance with generally accepted auditing standards and must:
set out the scope of the examination
provide an opinion as to the completeness and accuracy of the financial statement and whether it is free of material
misstatement
D Report is attached
Personal information, if any, collected on this form is obtained under the authority of sections 88.25 and 95 of the Municipal
Elections Act, 1996. Under section 88 of the Municipal Elections Act, 1996 (and despite anything in the Municipal Freedom of
Information and Protection of Privacy Act) documents and materials filed with or prepared by the clerk or any other election
official under the Municipal Elections Act, 1996 are public records and, until their destruction, may be inspected by any person
at the clerk's office at a time when the office is open. Campaign financial statements shall also be made available by the clerk
in an electronic format free of charge upon request.
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