CAMPAIGN FINANCE STATEMENT - Alison Connolly - 20230208Ontario Ministry of Municipal Affairs Financial Statement —
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) h oa a o ? I a.2 I to ,� C,d a I l o d Lf
Initial filing reflecting finances from start of campaign to December 31 (or 45 days after voting day in a by-election)
❑ Supplementary filing reflecting finances from start of campaign to end of extended campaign period
Box A. Name of Candidate and Office
Candidate's name as shown on the ballot
Last Name or Single Name Given Name(s)
C) k z Rvf s C)(ij
Office for Which the Candidate Sought Election Ward Name or Number (if any)
C) U iv C_ 1 1, c)1�� C
Municipality
U i� 0 Nf-)
Spending Limit Ill (f 1 a , 3 a Contribution Limit
General Parties and Other Expressions of Appreciation Contributions from Candidate and Spouse
❑ I did not accept any contributions or incur any expenses. (Complete Boxes A and B only)
Box B: Declaration
I, A 15 (, r, , w 6 t,L , declare that to the best of my knowledge and
belief that these financial statements and attached supporting schedules are true and correct.
Signature of Ca
Date Filed (yyyylmmldd) I Time Filed
,.h?m
A 0�3 09- 0
Date (yyyylmmldd)
Initial of Candidate or Agent (if filed in person)
Sign r of Clerk or Designate
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2.
+ $
3.
+ $
4.
+ $
5.
+ $
Total Expenses subject to spending limit for parties and other
expressions of appreciation
= $ C3
3. Expenses not subject to spending limits
Accounting and audit
+ $
Cost of fundraising 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)
C5
Box D: Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses
(Income minus Total Expenses) (Cl — C5) + $ 7 6 a cro D1
If there is a surplus, deduct any refund of candidate's or spouse's
contributions to the campaign — $ j 6 ! a 3
Surplus (or deficit) for the campaign = $ 7,0 -7 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.
13P (2022104) Page 3 of 7
�..b:M..H--- f—. ;.mvidualw other than candidate or spouse
f awe a: IYlVlrcaaly a•v uu wuw..•.-. ••�•
Name
- -
Full Address
Date Received
(yyyy/mm/dd)
Amount
Received ($)
Amount Returned
to Contributo r or
Paid to Clerk ($)
Total
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.)
Name Full Address Description of Goods Date Received Value ($)
or Services I (yyyylmmldd)
Total
Additional information is listed on separate supplementary attachment, if completed manually.
Total forPart III — Contributions exceeding $100 per contributor $ 1 B
(Add totals from Table 3 and Table 4 and record the total in Part 1 — Summary of Contributions)
Page 5 of 7
)3P (202Ua4)
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
Contact Information
Last Name or Single Name
Address
Suite/Unit Number I Street Number
Telephone
Street Name
Address
Given Name(s)
The report must be done in accordance with generally accepted auditing standards and must:
Date
Licence Number
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
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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