HomeMy WebLinkAboutPejic, Mirko - Financial StatementsMinistry of Municipal Affairs Financial Statement —
Ontario O
and Housing Auditor's Report Candidate — Form 4
Municipal Elections Act, 1996 (Section 88.25)
In )ctions
All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses must 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 clerk who is responsible
for the conduct of the election.
YYYY MM DD YYYY MM DID
For the campaign period from (day clerk received nomination) 1200,11 08 110 Ito I A021% I 1 O I ,2`1 I
❑ Initial filing reflecting finances from start of campaign to December 31 (or 45 days after voting day in a by-election)
❑ 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 IP r L G Given Name(s) M I RKo
Office for Which the Candidate Sought Election Ward Name or Number (if any)
M of 10 P,
Municipality �LoA t1A
Si, ing Limite 7 Contribution Limit
General / 3 Z/ $ 1 Parties and Other Expressions of Appreciation Contributions from Candidate and Spouse
$ 4ee!� Is 7034.6Zi $ Z22�% Lio.
91 did not accept any contributions or incur any expenses. (Complete Boxes A and B only)
Box B: Declaration
I, M I R k O 'p li-- C-/ declare that to the best of my knowledge and
belief that these financial statements a attached supporting schedules are true and correct.
Date (yyyyl(nm/dd)
Date Filed (yyyy/mm/dd) Time Filed Initial of Candidate or Agent (if filed in person) Signature of Clerk or Designate
80�3' oa� as 7 :13 aM . ` Vf
9503P (2022/04) 0 Queen's Printer for Ontario, 2022 Disponible an franrais Page 1 of 7
Box C: Statement of Campaign Income and Expenses
LOAN
Name of bank or recognized lending institution
INCOME
Total amount of all 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 III 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
+
$
Brochures/flyers
+
$
Signs (including sign deposit)
+
$
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.
+
$
Total Expenses subject to general spending limit
=
$ C2
2. Expenses subject to spending limit for parties and other expressions of appreciation
1.
+
$
Amount borrowed
$ i
C1
9503P (2022/04) Page 2 of 7
2.
+
$
3.
+
$
4.
+
$
5
+
$
1 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
+
$
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.
+
$
.,ier (provide full details)
1.
+
$
2.
+
$
3.
+
$
4.
+
$
5.
+
$
Total Expenses not subject to spending limits
= $ C4
Total Campaign Expenses (C2 + C3 + C4)
Box D: Calculation of Surplus or Deficit
Excess (deficiency) of income over expenses
(Income minus Total Expenses) (Cl — C5)
If there is a surplus, deduct any refund of candidate's or spouse's
contributions to the campaign
Surplus (or deficit) for the campaign
D1
C5
LEI
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.
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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 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 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
(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
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) I I I Value ($)
Total
❑ Additional information is listed on separate supplementary attachment, if completed manually.
Part III — Contributions exceeding $100 per contributor — individuals other than candidate or spouse
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Table 3: Monetary contributions from individuals other than candidate or spouse
Name Full Address Date Received Amount
(yyyy/mm/dd) Received ($)
Total
❑ Additional information is listed on separate supplementary attachment, if completed manually.
Amount Returned
to Contributor or
Paid to Clerk ($)
Table 4: Contributions in goods or services from individuals other than candidate or spouse
(Note: Must also be recorded as Expenses in Box C.)
Name Full Address Description of Goods Date Received Value ($)
or Services (yyyy/mm/dd)
Total
Additional information is listed on separate supplementary attachment, if completed manually.
Total for Part III — Contributions exceeding $100 per contributor
(A '-I totals from Table 3 and Table 4 and record the total in Part 1 — Summary of Contributions) $ 113
9503P (2022/04) Page 5 of 7
Schedule 2 — Fundraising Events and Activities
Complete a separate schedule for each event or activity held. ❑ 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
213
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 III — 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 III (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 — 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
ML
Contact Information
Last Name or Single Name
Address
Suite/Unit Number I Street Number Street Name
Municipality
Telephone Number
Email Address
Given Name(s)
Province
The report must be done in accordance with generally accepted auditing standards and must:
uate tyyyy/mm/aal
Licence Number
NOTOW
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
❑ 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
of I under the Municipal Elections Act, 1996 are public records and, until their destruction, may be inspected by any person
aL :'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.
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