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CAMPAIGN FINANCE STATEMENT - Alison Connolly - 20221024Ontario~ Ministry of Municipal Affairs and Housing Financial Statement - Auditor's Report Candidate -Form 4 Municipal Elections Act, 1996 (Sect ion 88.25) Instructions A ll candidates must comp lete Boxes A and B. Candidates who receive contributions or incu r expenses m ust complete Boxes C, D, Schedu le 1 and Schedule 2 as appropriate. Cand idates who rece ive con tribu tions o r in c ur expenses in ex cess 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 w ho is resp ons ib le for the conduct of the e lection . YYYY MM DD YYYY MM DD For the campaign period from (day clerk received nomination) Q oJ () I O ?)' I J:2 I to '-"la_ o ...... J:..:.......S.[}..'-'------'--! _D___.l_a__:.4-___JI ~ Initial filing reflecting finances from start of campaign to December 31 (or 45 days after vot in g day in a b y -election ) D Supp lem entary filing reflecting finances from start of campaign to end of extended campaig n period Box A: Name of Candidate and Office Candidate's name as shown on the ballot Last Name or Single Name ,:, 0 /,_ \. Office for Which the Candidate Sought Election f OU NC., / /-..l-.Of<._ Municipality UfoAA Spending Limit f L; 1 J _ I I 6 0 Given Name(s) A-~1S of\) Ward Name or Numbe r (if any) ~ Con tri bu ti o n Limit General c«../ Parties and Other Expressions of Appreciation Co ntrib utions fro~~ ~ ndidate and Spouse $ (!; f[ &.-~ b 0-$ I I ~ J-106 e, <:r LS"2 7o 6 D I did not accept any contributions or incur any expenses. (Complete Boxes A and B on ly) Box B: Declaration 1, A J-. I 5 0 n) e O A/ rJ O i,, A-y , decl are that to t he best of my know ledge and ' belief that these financial statements and attached supporting schedules are true and correct. Da te (yyy y/mm /dd ) Date Filed (yyyy/mm/dd) Time Filed 3 ·. \ M I nitial of Candidate or Agent (if filed in perso n) 9503P (2022 /04) © Qu een 's Printer fo r Ontar io, 2022 Disponible en f ran~ais Page 1 of 7 --------------------------------- ------- ------- ------- ------- ------- ------------------------------- ------- ------- ------- Box C: Statement of Campaign Income and Expenses LOAN Amount borrowed Name of bank or recognized lending institution sen/ fl f} fl fl) k · ''lo N G-1: Si' fl U (( 0 If /1 · $ ff INCOME Total amount of all contributions (from line 1A in Schedule 1) + $ l~co Revenue from items $25 or less + $ ....e- Sign deposit refund + $ Revenue from fundraising events not deemed a contribution (from Part Ill of Schedule 2) + $ -tJ Interest earned by campaign bank account + $ ,0 Other (provide full details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ 6. + $ Total Campaign Income (Do not include loan) = $ / 7 o o •. 6 c, C1 EXPENSES (Note: Include the value of contributions of goods and services) 1. Expenses subject to general spending l imit In ventory from previous campaign used in this campaign (list details in Table 2 of Schedule 1) + $ ::9: Advertising + $ Brochures/flyers '3 8 4 s:~ + $ · Signs (including sign deposit) + $ is<?-, 1 Meetings hosted + $ --0- Office expenses incurred until voting day + $ :fr Phone and/or internet expenses incurred until voting day + $ :B::: Salaries , benefits, honoraria, professional fees incurred until voting day + $ --fr Bank charges incurred until voting day + $ 31 · 15: Interest charged on loan until voting day + $ 'tr Other (provide full details) 1. ~ ·10 ,v f,,/ C' (;',vSC. + $ :J.76 ·crO 2 · 1:\8 ROW 8 Ri; + $ 3 g . d lf 3. + $ 4. + $ 5. + $ 6. + $ Total Expenses subject to general spending limit = $ I 6 I :} -13 c 2 2. Expenses subject to spending limit for parties and other expressions of appreciati on 1. + $ Page 2 of 7 9503P (2022/04 ) ------------------------- ------------------------- ------------------------- ------------------------- 2. + $ 3 . + $ 4 . + $ 5 . + $ Tot a I 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 fund raising events/activities (list detai ls in Part IV of Schedu le 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 + $ I nterest charged on loan after voting day + $ Expenses re lated to recount + $ Expenses re lated to controverted e lection + $ Expenses re lated to comp liance audit + $ Expenses re lated to candidate's disabil ity (provide full details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ Other (provide fu ll details) 1. + $ 2 . + $ 3. + $ 4. + $ 5. + $ Total Expe nses not subject to spending limits = $ C4 Tot al Campaign Expe nses (C2 + C3 + C4) \ b \2 .cr s = $ C5 Box D: Calculation of Surplus or Deficit Excess (deficiency) of income over expenses 81", 0"1" (Income minus T ota l Expenses) (C1 -C5) + $ r+ e& ~t, 01 If there is a surp lus, deduct any refund of candidate's or spouse's S-=t , o ~ contributions to the campaign -$ Hta -~:3-¢ Surplus (o r deficit) for the campaign = $-8-'f ~ 7 D2 If line 02 shows a surplus, the amount must be paid in trust, at the time the financ ial statements are filed , to t he mun ic i pal clerk who is respons ible for the conduct of the election. 13P (2022/04 ) Page 3 of 7 Schedule 1 -Contributions Part I -Summary of Contributions Contributions in money from cand idate and spouse + $ l-=l-00 Contributions in goods and services from ca ndidate and spouse (i nclude 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 in clude contributions from candidate or spouse). + $ T ota l valu e of contributions exceeding $100 per contributor (from lin e 1 B ; list details i n T ab le 3 and Tab le 4 ) • Include t icket r evenue, contributions in money, goods and services where the total co nt ribution from a contributor exceeds $100 (do not include co ntributions from candidate or spouse). + $ Less: Ineligible contributions pa id 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 C) = $ 13:00 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 ($) Total D Additional i nformation is listed on separate supplementary attachment, if completed manually. Table 2: Inventory of campaign goods and materials from previous municipal campaign used in this campaign (Note : Value must be recorded as a contribution from the cand idate and as an expense.) Description Date Acquired (yyyy/mm/dd) Supplier Quantity Current Market Value ($) Total D Additiona l information is listed on separate supplementary attachment, if complet ed manually. Part Ill -Contributions exceeding $100 per contributor-individuals other than candidate or spouse 9503P (20 22/0 4) Pa ge 4 of 7 ------ Table 3: Monetary contributions from individuals other than candidate or spouse Name Full Address Date Received Amount Amount Returned (yyyy/mmldd) Received ($) to Contributor or Paid to Clerk ($) Total D Additional information is listed on separate supplementary attachment, if completed manually. Table 4: Contributions in goods or services from individuals other than candidate or spouse (Note: Must also be recorded as Expenses in Box C.) Name Full Address Description of Goods or Services Date Received (yyyylmmldd) Value($) 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) $ 16 j3P (2022/04) Page5of7 ------------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------- ---------------------------------- -------------------------------- ---------------------------------- ---------------------------------- -------- -------- -------- Schedule 2 -Fundraising Events and Activities Complete a separate schedule for each event or activity held. 0 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 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) = $ 9503P (2022/04) Page 6~7 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 I Date (yyyy/mm/dd) Municipality 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 of 7 9503P (2022/04) '