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CAMPAIGN FINANCE STATEMENT - Anna Lozyk Romeo - 20221024Ministry of Municipal Affairs Financial Statement -Ontario& and Housing Auditor's Report Candidate -Form 4 Municipal Elections Act, 1996 (Section 88.25) Instructions All candidates must complete Bo xes A and B. Candidates who receive contributions or incu r expenses must complete Bo xes C , D, Schedule 1 and Schedule 2 as appropriate. Candidates who receive contribut ions or incu r 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 pa id to the cler k who is responsib le for the conduct of the election. YYYY MM DD YYYY MM DD For the campaign period from (day clerk received nomination) 12 0 2 21 0 a I 1 91 to I 2 0 2 2 I 1 2 I 3 1 I (Z] Initial filing reflecting finances from start of campaign to December 31 (or 45 days after voting day in a by-election ) D 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 Lozyk Romeo Office for Which the Candidate Sought Election Mayor Municipality Town of Aurora Spending Limit Given Name(s) Anna Ward Name or Number (if any) Contribution Limit Parties and Other Expressions of Appreciat io n Contributions from Candidate and Spouse General $4,415.20 $16,124.00 $44,152.00 D I did not accept any contributions or incur any expenses. (Complete Boxes A and B only ) Box B: Declaration , declare that to the best of my knowledge and I, Anna Lozyk Romeo belief that these financial statements and attached supporting schedules are true and correct. 2u2 3 --o 3-22 Date (yyyy/mm/dd ) Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (if filed in person) o : st (;JV\ ~ lJs Page 1 of 7 9503P (2022/04) © King's Printer for Ontario, 2022. Disponible en frarn;a is ------------------------- ------------------------- ------------------------- ------------------------ ---------------------- ------------------------ ------- Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending institution Amount borrowed $ INCOME Total amount of all contributions (from line 1A in Schedule 1) + $ 5,877.73 Revenue from items $25 or less + $ + $ Sign deposit refund Revenue from fundraising events not deemed a contribution + $ (from Part Ill of Schedule 2) Interest earned by campaign bank account + $ Other (provide full details) + $ 1. + $ 2. + $ 3. + $ 4. -------------------------+ $ 5. + $ 6. Total Campaign Income (Do not include loan) =$ 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 + $ 1,638.50 Brochures/flyers + $ 527.71 Signs (including sign deposit) + $ 1,683.75 + $ 565.00 Meetings hosted Office expenses incurred until voting day + $ 9.89 Phone and/or internet expenses incurred until voting day + $ 231.98 Salaries, benefits, hanararia, professional fees incurred until voting day + $ -'------- Bank charges incurred until voting day + $ 14.52 Interest charged an loan until voting day + $ Other (provide full details) 1. York Region Sign Permit + $ 270.00 2. Sign Installation Supplies + $ 412.13 3. Canada Post Mailing Fee + $ 504.25 4. + $ 5. + $ 6. + $ Total Expenses subject to general spending limit = $ 5,857.73 C2 2. Expenses subject to spending limit for parties and other expressions of appreciation 1. + $ 5,877.73 C1 Page 2 of7 9503P (2022/04) ------------------------ ---------------------- ------------------------ ------- ------- ------- ------- ------- ------------------------ ------------------------ ------------------------ ------------------------ 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 + $ 20.00 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 = $ 20.00 C4 = $ 5,877.73 C5 Total Campaign Expenses (C2 + CJ + C4) Box D: Calculation of Surplus or Deficit Excess (deficiency) of income over expenses (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 Surplus (or deficit) for the campaign - $ = $ 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. Page3of7 9503P (2022104) Schedule 1 -Contributions Part I -Summary of Contributions Contributions in money from candidate and spouse + $ 4,142.73 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 285.00 (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 1,450.00 (do not include contributions from candidate or spouse). + $ Less: Ineligible contributions paid or payable to the contributor -_,$'--------- Contributions paid or payable to the clerk, including contributions from anonymous sources exceeding $25 -$ -'-------- Total Amount of Contributions (record under Income in Box CJ = $ 5,877.73 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($) Total O Additional information is listed on separate supplementary attachment, if completed manually. Table 2: Inventory of campaign goods and materials from previous municipal campaign used in this campaign (Note: Value must be recorded as a contribution from the candidate and as an expense.) Description Date Acquired Supplier Quantity Current Market (yyyy/mm/dd) Value($) Total O Additional information is listed on separate supplementary attachment, if completed manually. Part Ill -Contributions exceeding $100 per contributor -individuals other than candidate or spouse Page4 of7 9503P (2022/04) Table 3: Monetary contributions from individuals other than candidate or spouse Name Full Address Date Received Amount (yyyy/mm/dd) Received ($) Douglas Alderson 87 Benville Crescent 2022/09/15 500.00 Aurora, Ontario, L4G 7K2 Ryan Shephard 274 Touch Gold Cres 2022/10/06 750.00 Aurora, Ontario, L4G 3X5 Steffanie Wang 40 Ridge Road 2022/10/19 200.00 Aurora, Ontario, L4G OM3 Total 1,450.00 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.) Amount Returned to Contributor or Paid to Clerk ($) 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 $100 per contributor (Add totals from Table 3 and Table 4 and record the total in Part 1 -Summary of Contributions) 9503P (2022/04) Value($) $ 1,450.00 1B Page 5 of7 --------------------------- ------- ------- ------- ------- ------- ------- ------- ------- ----------------------- ------------------------- -------------------------------- ----------------------- ------------------------- ------------------------- ------------------------- 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 Description of fundraising event/activity 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 2B) (include in Part I of Schedule 1) = $ Part 11-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) = $ Page 6 of7 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 I Date (yyyy/mm/dd) Contact Information Given Name(s) Licence Number Last Name or Single Name Address Suite/Unit Number Street Number Street Name Municipality Province Postal Code Telephone Number Email Address 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. Page 7 of7 9503P (2022/04)