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CAMPAIGN FINANCE STATEMENT - Sandra Humfryes - 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 Boxes A and B. Candidates who receive contributions or incur exp enses must complete Boxes C, D , Schedule 1 and Schedule 2 as appropriate. Candidates who receive contribu tions 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 paid to the cle rk w ho is responsib le for the conduct of the election. YYYY MM DD YYYY MM DD For 7e campaign period from (day clerk received nomination) I Qod-d.. lo~ l~l I to j .Q.o~ j JO I ~ J.f I [J/initial filing reflecting finances from start of campaign to December 31 (or 45 days afte r voting day in a by-e lection) 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 ~ Office for Which the Candidate Sought Ele ction Ward Name or Number (if any ) ~ Municipality /\ t)j)\) Spending Limit Contrib utio n Limit General Parties and Other Expressions of Appreciation Contrib uti ons from Candidate and Spouse $ c;; $ l \ $ I 55 . D I did not accept any contributions or incur any expenses. (Complete Boxes A and B on ly) Box B: Declaration , declare that to th e best of my k nowledge and belief that these financial statements and attached supporting schedules are true and co r rect. ~ ~of Candidate Date (yyyy/mm/dd) Date Filed (yyyy/mm/dd) Time Filed l 2.:. Sof>f'-'l In itial of Candidate or Agent (if filed in person) of Clerk ,or Designate 9503P (2022/04) © Queen's Printer for Ontario, 2022 Oisponible en franc;:ais Page 1 of 7 ------- --------------------------------- ------- ------- ------- ------- ------- ------------------------------- ------- ------- ------- ------- Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending institution Amo u nt borro wed $ INCOME Total amount of all contributions (from line 1A in Schedule 1) + $ 4DG5 . 62 Revenue from items $25 or less + $ Sign deposit refund + $ Revenue from fundraising events not deemed a contribution (from Part Ill of Schedule 2) + $ I nterest 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) + $ I 000 . ~[) Advertising + $ \ ':::\11,55 Brochures/flyers $ <30\~-3~ + Signs (including sign deposit) + $ b<N.C\S Meetings hosted + $ Office expenses incurred until voting day + $ Phone and/or internet expenses incurred until voting day + $ Salaries, benefits, honoraria , professional fees incurred until voting day + $ Bank charges incurred until voting day + $ Interest charged on loan until voting day + $ Other (provide full details) 1. + $ 2. + $ 3. + $ 4. + $ 5. + $ 6 . + $ = $ 'io,s . s2 c1 Total Expenses subject to general spending limit =_$ ~,0\6 , 52 C2 2. Expenses subject to spending limit for parties and other expressions of appreciation 1. + $ 9503P (2022 /0 4) 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 fund raising e vents/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, profes s ional fees incurred after voting day + $ Bank c harges incurred after voting day + $ Interest charged on loan after v oting day + $ E xpenses related to recount + $ E xpenses related to controverted election + $ E xpenses related to comp li ance audit + $ E xp enses related to candidate's disability (provide full det ails ) 1. + $ 2 . + $ 3 . + $ 4. + $ 5 . + $ Other (p ro vi de fu ll deta ils ) 1. + $ 2. + $ 3 . + $ 4 . + $ 5 . + $ Total Expenses not subject to spending limits = $ C4 Total Campaign Expenses (C2 + C3 + C4) = $ l-\o~s . sz.. cs Box D: Calculation of Surplus or Deficit Ex cess (deficiency) of income over expenses (In come minus Tota l E xpenses) (C1 -C5) D1 0 If If there is a surplus, deduct any refund of candidate's or spouse's , .....---::;::: f O ~ IA. I 1 1 contributions to the campaign $ 3 1 ~ '¥ 0 l?f Surplus (o r deficit) for the campaign 7 = $ -~ D2 fj/ If line D2 sh ows a surplus, the amount must be paid in trust, at the time the financia l s tat eme nts are fi led , to~ _;;clerk who is resp onsible for the conduct of the election . 9503P (2022/04) Page 3 of 7 Schedule 1 -Contributions Part I -Summary of Contributions Contributio ns in money from candidate and spouse Contributions in goods and services from candidate and spouse (include value listed in Table 1 and T ab le 2) Total va lue of contributions not exceeding $100 per contributor • I nclude ticket revenue, contributions in money, goods and services where the total contribution from a contributor is $100 or less ( do not include contribu t ions from candidate or spouse). Total va lue of contributions exceed ing $100 per contributor (from line 1 B; list details in Table 3 and Table 4) • I nc lude ticket revenue , contributions in money, goods and services where the tota l contribution from a contributor exceeds $100 (do not include contributions from candidate or spouse). Less: Ineligible contributions pa id or payable to the contributor Contributions pa id or payable to the clerk, including con t ributions from anonymous sources exceed ing $25 Total Am oun t of Co ntrib utions (record u nd er Inco m e in Box C) Part II -Contri butions from candidate or spouse Table 1: Contributions in goods or services + $ '-1 GS S 2- + $ + $ + $ 3\d:i) \ ~\) -$ -$ = $3.a:bc * -1A LIO~S .'52-If Desc ript ion of Goods or Services Date Received (yyyy/mm/dd) Value($) Total D Additiona l information is listed on separate supplementary attachment, if completed manually. Table 2: Inventory of campa ign goods and materials fro m prev io us m unicipal campaig n used in this campaign (Note: Value must be recorded as a contribution from t he candidate and as an expense .) Descri ption Date A cq uired (yyyy/mm/dd) Suppli er Quantity C urrent Market Value($) ~\~ \.i\.~~s\~~s J.o\ i\tf\\i.,~ ~ \h_\tm~G So ~ \tiXY 00 Total _!~~(::J:'yO~ D Additional information is listed on separate supplementary attachment, if completed manually. Part Ill -Contributions exceeding $100 per contributor-indiv iduals other than candidate or spouse 9503P (2022/04) Page 4 o f 7 Table 3: Monetary contributions from individuals other than candidate or spouse Name ~ ~ (?,_\l:)'\"\ _<_I[_,'\ \,\ (\C.~ b.~U)\W?-- 1\1\\ h I\ (\ I tJ\ f I""\ Full Address Date Received Amount (yyyy/mm/dd) Received ($) "'~ 'S\f\t" ~ "~ ~,;:,~\1.3 \~t,t) I~ ~l, ~~~ \)~\\~ ')_Gll..,\ I ol 13 \~C')() '00 .-.;l>Qb~V v\'\N Ub l.'1~ K1•'c> ,~"'°· -· ""r. ,.v, ~1Dl23 \ :to::, 1\)\) Amount Returned to Contributor or Paid to Clerk ($) t,J / I\ NI.\\ I\.) I .I\. Total ~6c:o,o:, D Additional information is listed on separate supplementary attachment, if completed manually. Table 4: Contributions in goods or services from individuals other than candidate or spouse (Note: Must also be recorded as Expenses in Box C.) Name Full Address Description of Goods or Services Date Received (yyyy/mm/dd) Value($) 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) 1B 9503P (2022/04) 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 2B Total Part I (2A X 2B) (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 of7 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 Last Name or Single Name Given Name(s) Licence Number Address Suite/Unit Number I Street Number I 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) Page7of7