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CAMPAIGN FINANCE STATEMENT - Iwona Czarnecka - 20221024Ministry of Municipal Affairs Financial Statement -Ontarioil and Housing Auditor's Report Candidate -Form 4 Municipal Electi ons Act, 1996 (Section 88.25) Instructions All candidates must complete Boxes A and B. Candidates who receive contributions or incu r expenses mu st 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 cl er k who is responsible for the conduct of the election . YYYY MM DD YYYY MM DD For the campaign period from (day clerk received nomination) I 202z...-llr'l I {-=l--I to ~I 4)_~<2_-'-l li. _._' ___ l 3-=-,_[ -'I 12] Init ia l filing refle cting finances from start of campaign to December 31 (or 45 days after voting day in a by-election) 0 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 Czarnecka Office for Which the Candidate Sought Election Councillor Municipality Auora Spending Limit Given Name(s) lwona Ward Name or Number (if any ) Ward 4 Contri bution Limit General Parties and Other Expressions of Appreciation Contributions from Candidate and Spouse $9 ,272 .95 $927 .30 $6 ,005.40 D I did not accept any contributio ns or incur any expenses. (Com plete Boxes A and B only) Box B: Declaration I, lwona Czarnecka , declare that to th e best of my knowledge and belief that these financial statements and attached supporting schedules are true and co r rect. Signature of Candidate 2023/03 /28 Date (yyyy/mm /dd ) of Clerk or Designate Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (i f filed in person) 1:so 9503P (2022/04) © Queen's Prin ter for Ontario , 2022 Di sponible en fran9ais Page 1 of 7 ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- ------- ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending institution Amount borrowed RBC $ INCOME Total amount of a ll contributions (from line 1A in Schedule 1) + $ 1 ,600.00 Revenue from items $25 or less + $ Sign deposit refund + $ Rev enue from fundraising events not deemed a contributi on (from Part Ill of Schedule 2) + $ I nterest earned by campaign bank account + $ O t her (provide fu ll details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ 6. + $ Total Campaign Income (Do not include loan) = $ 1,600 .00 C1 EXPENSES (Note : In clude the value of contributions of goods and services) 1. Expenses subject to general spending l imit Inventory from previous campaign used in this campaign (list detai ls in Table 2 of Schedule 1) + $ Advertising + $ 97 .62 Brochures/flyers + $ 339.00 Signs (including sign deposit) + $ 542 .19 Meetings hosted + $ Office expenses incurred until voting day + $ Phone and/or internet expenses incurred until voting day + $ Salaries, benefits, honoraria , professional fees incurred unti l voting day + $ 585 .69 Bank charges incurred until voting day + $ 12.50 Interest charged on loan until voting day + $ Other (provide full details) 1 . + $ 2 . + $ 3. + $ 4. + $ 5 . + $ 6 . + $ Total Expenses subject to general spending limit = $ 1,577.00 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 = $ C3 3. Expenses not subject to spending limits Accounting and audit + $ Cost of fundraising events/activiti es (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 + $ 5.00 Interest charged on loan after vo ting day + $ Expenses related to recount + $ Expenses related to controverted election + $ Expenses related to comp liance audit + $ Expenses related to candidate's disability (provide full details) 1. + $ 2. + $ 3 . + $ 4 . + $ 5. + $ Other (provide full detai ls) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Total Expenses not subject to spending limits = $ 5 .00 C4 Total Campaign Expenses (C2 + C3 + C4) = $ 1,582.00 cs Box D: Calculation of Surplus or Deficit Excess (deficiency) of incom e over expenses (Income minus Total Expenses) (C1 -C5) + $ 18 .00 01 If there is a surplus, deduct any refund of candidate 's or spouse 's contributions to the campaign -$ Surplus (or deficit) for the campaign = $ 1 8 .00 02 If line 02 shows a surplus , the amount must be paid in trust, at the time the financia l statements are filed, to the mun icipal clerk who is responsible for the conduct of the election . 9503P (2 022/0 4) Page 3 of 7 -------- Schedule 1 -Contributions Part I -Summary of Contributions Contributions in money from candidate and spouse + $ Contributions in goods and services from candidate and spouse (include va lue listed in Table 1 and Table 2) + $ T otal va lue of contributions not exceed ing $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 contributio ns from candidate or spouse). + $ Total va lue of contributions exceeding $100 per contributor (from line 1 B ; list details in Table 3 and Table 4) • Inc lude 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). + $ 1 ,600 .00 Less: Ine ligible contributions paid or payable to the contributor -$ Cont rib u ti on s paid or payab le to the clerk , including contribut ions from anonymous sources exceeding $25 -$ Total A mou nt of Contributions (record under Income in Box C) = $ 1,600 .00 1A Part II -Contributions from candidate or spouse Table 1: Contributions in goods or services Description of Goods or Services Date Received Value ($) (y yyy/mm /dd) Total D Additional information is listed on separate supplementary attachment, if completed ma nu ally. Table 2: Inventory of campa ign goods and materials from previous mun i cip al campaign used in this campaign (Note: Value must be recorded as a contribution fro m the candidate and as an expense.) Description Date Acq ui red Supplier Quantity C urre nt Market (yyyy/mm/dd) Va lue($) Total D Add itiona l infor ma tion is lis ted on separate supplemen tary attachment, if comp leted m an uall y. Part Ill -Contributions exceeding $100 per contributor -individuals other than candidate or spouse 9503P (2022/04) Page 4 of 7 Table 3: Monetary contributions from individuals other than cand idate or spouse Name Full Address Date Received Amount Amount Returned (yyyy/mm /dd ) Received ($) to Contributor or Paid to Clerk ($) Douglas Alderson BENVILLE CRESCENT 2022 /09 /19 500 .00 Aurora , ON , L4G 7K2 Canada Gary Lee 18 Deerglen T er race , 2022/09 /2 4 100.00 Aurora , On . L4G6Y2 Roya Rezaee 12 Steeplechase Ave, 2022 /10/03 1,000.00 A urora , ON L4G 6W5 Total 1,600.00 D Add itional information is listed on separate supplementary attachment, if completed manu ally . 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 I 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 $100 per contributor (Add totals from Table 3 and Table 4 and record the total in Part 1 -Summary of Contributions) 9503P (2022104) Value($) $ 1,600.00 18 Page 5 of 7 ------------------------------ ------- ------- ------- ------- ------- ------- -------------------------------- ------- ------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- 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 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) = $ 9503P (2022/04) Page 6 of 7 Auditor's Report -Mllnicipal 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 (yyyyimm/dd) Contact Information Last Name or Single Name Given Name(s) Licence Number 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. 9503P (2022/04) Page 7 of 7