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CAMPAIGN FINANCE STATEMENT - Bridget Kilgallon - 20221024_ _ ")·-.. Ministry of Municipal Affairs Ontario& Financial Statement-and Housing Auditor's Report Candidate -Form 4 Municipal El ections Act, 1996 (Section 88.25) Instructions A ll candidates must comp lete Boxes A and 8 . Candidates who rece ive contributions o r inc ur expenses must comp le te Boxes C, D, Schedu le 1 and Schedu le 2 as appropriate . Candidates who receive cont ributi o ns or incu r expe nses in excess of $10,000 must also attac h an Auditor's Report. A ll surp lus funds (after any refund to the candidate or their spouse) shall be immed iately paid to the clerk who is re sponsib le for the conduct of the e lection . YYYY MM DD YYYY MM DD For the campaign period from (day clerk received nomination) I ). t> a~ j 61 I tJ I to __t ~,;). __.__o_J_ _ __J L_, ~_,_ ~ In itial fi ling reflecting finances from start of campaign to December 31 (or 45 days after vot ing day in a by-election ) D Supplementary filing reflecting finan ces from start of campaign to end of extended ca mp aign period Box A: Name of Candidate and Office Candidate's name as shown on the ballot Last Name or Sing le Name K l l.~-AI..J-01.J Office fo r Which the Candidate SOJ:!9Qt Election $C~L ..6(>AAJ) -r.c."l.S-ra: Given Name(s) s~r t>'-e:--r Ward Name or Number (if anyL ~AA /S1bUf'PVlL €' Spending Limit Contribution Li mit Parties and Other Expressions of Appreciatio n Contributions from Candi date and Spouse ~ ~O;o'3'}· /<1 $ ~ ('.'.)<='3 , Ef) $ D I did not accept any contributions or incur any expenses. (Complete Boxes A and B on ly) Box B: Declaration , decla re that to the best of my knowledge and belief that these financia l statements and attached supporting schedules are true and correct. Signature of Cand idate Date (yyyy/mm/dd ) Date Filed (yyyy/mm/dd) Time Filed ~/63/&( Initial of Candidate or Agent (if fi led in pe rson ) ~ 9503P (2022/04) © Queen 's Printer for Ontario, 2022 Disponible en fran9ais Page 1 of 7 ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending institution ~d $ INCOME Total amount of a ll contributions (from line 1A in Schedule 1) + $ Revenue from items $25 or less + $ Sign deposit refund + $ Revenue from fundraising events not deemed a contribution (from Part Il l of Schedule 2) + $ Interest earned by campaign bank account + $ Other (provide fu ll detai ls) 1. + $ 2 . + $ 3 . + $ 4. + $ -------------------------- 5. + $ -------------------------- 6. + $ -------------------------- Tot a I Campaign Income (Do not include loan) EXPENSES (Note: Include the value of contributions of goods and serv ices) = $ C1 1. Expenses subject to general spending limit Inventory from previous campaign used in this campaign (list details in Table 2 of Schedu le 1) Advertising Brochu res/flyers S igns (including sign deposit) Meetings hosted Office e xpenses 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 I nterest charged on loan until voting day Other (provide full details) 1. + $ + $ l,S~o·ff + $ /,6~0 ·" + $ + $ + $ + $ + $ + $ + $ + $ 2. + $ 3. + $ 4. + $ 5. + $ 6. + $ Tot a I Expenses subject to general spending limit = $ ,.,,,, ~ ·'° C2 2. Expenses subject to spending lim it fo r parties and other expressions of appreciation 1. + $ 9503P (2022/04 ) Pag e 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 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 + $ --'-------- Sa I a r i es, 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) = $ cs 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. 9503P (2022/04) Page 3 of7 -------- 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 value listed in Table 1 and Table 2 ) + $ Total va lue of contributions not exceeding $100 per contributor • Include ticket revenue , contributions in money, goods and services where the tota l contribution from a contributor is $100 or less 0 (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) • In clude 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). + $ 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 C) = $ 1A Part II -Contributions from candidate or spouse Table 1: Contributions in goods or services Description of Goods or Services Date Received (yyy y /mm/dd) Total Value ($) D Additional information is listed on separate supplementary attachment, if completed manually . Table 2: Inventory of campaign goods and materials from previous municipal campaign used in this campaign (Note: Value must be recorded as a contribution from the candidate and ~ an expense.) Description Date Acquired Suppli~ Quantity Current Market (yyyy/mm/dd) Value ($) V / V 7 / 7 Total D Additional information is listed on separate supplementary attachment , if comp le t ed manually . Part Ill -Contributions exceeding $100 per contributor -individuals other than candidate or spouse 9503 P (202 2/04) Page 4 of 7 ------ Table 3: Monetary contributions from individuals other than candidate or spouse Name Full Address Date Received Amount (yyyy/mm/dd) Received ($) --~ / V / / Total Amount Returned to Contributor or Paid to Clerk ($) D Additiona l information is listed on separate supplementary attachment, if comp lete d manually. Table 4: Contributions in goods or services from individuals other than candidate or spouse (Note: Must also be recorded as Expenses in Box C.) Name Full Address I Description of Goods or Services Date Received (yyyy/mm/dd) Value($) / I I / Total D Additiona l information is listed on separate supp lementary 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) $ 18 9503P (2022/04) 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 comp lete breakdown of all tic sales) Number of tickets sold X 28 Tota l Part I (2A X 28) (include in Part I of Schedule 1) = $ Part 11-Other revenue deemed a contribution Provide detai ls (e.g., revenue from goods sold in excess of fa' 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 r $25 or less ) 1. + $ -------------------~r------- 2 . + $ = $ ,J/ + - 3. + $ ------------------'-------- 4. + $ + $ 5. Total Part Ill (include under Income in Box C) = $ Part IV -Expenses related to fundraising event or activity ~, fr Provide details + $ 1. -----------------------+--- 2. + $ 3. + $ ----------------------+---- 4. + $ 5. + $ Total Part IV Expenses (include under Expenses in Box C) = $ 9503P (2022104) Page 6 of 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 attac h an auditor's rep ort. Professional Designation of Auditor av A-, Municipality Date (yyyy/m m/dd ) Contact Information Last Name or Sing le Name Given Name(s) Licence Num ber 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 financia l state men t and w hether it is free of material misstatement D Report is attached Personal information , if any, coll ected on this form is obtained under the authority of sections 88 .25 a nd 95 of t he Municipal Elections Act, 1996. Under section 88 of the Municipal Elections Act, 1996 (and despite anyth in g in the M unicipal Freedom o f Information and Protection of Privacy Act) documents and materials filed with or prepared by the c lerk o r any oth er electi o n official under the Municipal Elections Act, 1996 are public records and , until their destruction , may be inspected by an y pe rson at the clerk's office at a time when the office is open. Campaign financia l statements shall also be made av ailable by th e clerk in an electronic format free of charge upon request. 9 5 03 P (2022104 ) Page 7 of 7