D $500 late filing fee (if filed between March 20, 2012, and April 18, 20 12) CAMPAIGN ORGANIZER/ELECTOR ORGANIZATION

Transcription

1 Form 0.1: Cover Sheet and Check List Election Campaign Financing Report CAMPAGN ORGANZER/ELECTOR ORGANZATON PLEASE PRNT N BLOCK LETTERS This campaign financing report includes the following completed forms and schedules: g 0.1: Cover Sheet and Check List Gf 0.2: Declaration for Campaign Organizer/Elector Organization and Financial Agent ~/ 0.3: Campaign Financing Disclosure Summary Schedules c:;r A.1: Summary of Campaign Contributions [J A.2: Campaign Contributors Q" B: Election Expenses D 500 late filing fee (if filed between March 20, 2012, and April 18, 20 12) [21/ C: Surplus Funds Disbursement NOTE: Do not include record-keeping forms in the financial disclosure pages submitted to the designated local government officer. Record-keeping forms are for candidate, campaign organizer, elector organization and financial agent use only. Do not disclose additional information on disclosure forms (e.g. personal information not required by legislation)- even if it has been captured through the record-keeping process. MNSTRY Of COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

2 Form 0.2: Declaration for Campaign Organizer/Elector Organization and Financial Agent DECLARATON OF CAMPAGN ORGANZER/ELECTOR ORGANZATON, ~ t. ~'~.: ~name of official], an authorized representative of~c\.1& ~ (1(,. ~(\~ [name of campaign organizer/ elector organization in th(*',\j\)a"'..;:,~ [name of local government] election, solemnly affirm that to the best of my knowledge, information and belief: (a) this campaign financing disclosure statement and supporting schedules completely and accurately disclose the information required by section 90 of the Local Government Act (or secti n 62 of the Vancouver Charter) in relation to the election campaign in th~ [year] general local election for the(t ' ~ t.~,.,..:) [name of local government]; and (b) the requirements of Part 3, Division 8 of the L~cal Gcw:_~nment Act (or Part 1, Divisi~n 8 of the Vftn ouver Charter) have been met 1n relat1on to the election campa1gn 1n th~;;; \ [year] general local elect1on for the L~.: ll ~"~ [name of local government]; Solemnly affirmed before me at ~me::>, British Columbia this <(;,~ of 'fi:\ona,y;;l.~\")... al government officer or Commissioner for taking affidavits for B.C. DECLARATON OF FNANCAL AGENT, VU1'k~ A \\<J.J [name of financial agent], have prepared this disclosure statement and supporting schedules for l\j,...,,.?.~<uf f;rt ~~~ l".: ;[name of campaign organizer/elector organization] and solemnly affirm that to the best of my knowledge, informationvand belief: (a) this campaign financing disclosure statement and supporting schedules completely and accurately disclose the information required by section 9 of the Local Government Act (or section 62 of the Vancouver Charter) in relation to the election campaign oftjav.'\>,"ti~. k ~~">[name of campaign organizer/elector organization] in the i [year] general local election for the L\ \J ~ t-jl!v 1'!.\"0 [name of local government]; and -- (b) the requirements of Part 3, Division 8 of the Loc1 Go~ernme~t Act (or Part 1, Divisi.on 8 of the Vancouver Charter) have been met 1n relat1on to the election campa1gn of~"'?..:., f,.ct {;,.lt.i<>~ 2ul\ [year] general local election for the C;t 7 ~f [name of campa1gn organizer/elector organization] n the ~.;.:<,[name of local government]. Solemnly affirmed before me at ~~t).,""'s:;), British Columbia this "8,~ of'si1>~j-~tll:l. Signature of Financial Agent MNSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

3 Form 0.3: Campaign Financing Disclosure Summary CAMPAGN FNANCNG DSCLOSURE STATEMENT FOR THE 2011 GENERAL LOCAL ELECTON Local Government Act [section 90] or Vancouver Charter [section 62] This car.npaign financing disc,losure statement is to be filed with the designated officer of the C, \l b-1 N41/\q\i''N"" [local government] w1thm 120 days after general voting day on November 19, This deadline is March 19, tj~"'c.\'"" 1 ~h-)~fl>r,ttl f1 rfl -h.j\~ J:- A ~f k ql <tos NAME OF CAMPAGN ORGANZER/ELECTOR ORGANZATON NAME OF CANDDATE(S) ENDORSED (Elector Organization only) SUMMARY OF CAMPAGN CONTRBUTONS Total amount of campaign contributions (Total from Schedule A.1) List of contributors who made contributions totalling 100 or more (See Schedule A.2) Total amount of anonymous campaign contributions remitted to the local government (Total Schedule A.2) J:c SUMMARY OF ELECTON EXPENSES Total amount of election expenses (Total from Schedule B) List of election expenses by expense class (See Schedule B) SURPLUS FUNDS Balance remaining in elector organization/campaign organizer campaign account See Schedule C for disbursement of surplus funds CAMPAGN ACCOUNT NFORMATON All monetary contributions were deposi~ed in, and all election expense.s paid fro;n r, an account opened for this purpose at G!-01l~( ~,flt\r..v.!j!ll located at ll-s? \.J~,..i+ ~a me o~ina~ci_al institution] [branch address] ~~~ Vv1c~"' 1\Jq-Nd.~ MNSTRY Of COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

4 Schedule A.1 - Summary of Campaign Contributions Contributions from known sources: Total value of contributions of 100 or more from a single source (unless nil, also complete schedule A.2) Total value of contributions of or less from a single source Total number of contributions of or less from a single source s 139?.:n 17 Contributions from unknown (anonymous) sources: Total contributions from anonymous sources Less anonymous contributions remitted to local government Total amount of anonymous contributions of 50 or less Total amount of contributions: A+B+C c Rr 7{88J; MNSTRY Of COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

5 Schedule A.2- Campaign Contributors 1. ndividuals (class 1) contributing 100 or more: Table R 1: Class of Contributors: :. 1. ndividual 2. Corporation/Business 3. Unincorporated Organization 4. Trade Union 5. Non-Profit Organization 6. Other Contributor 3. Anonymous contributions remitted to local government: DATE RECEVED (DD-MM-YY) CONTRBUTON VALUE DATE REMTTED (DD-MM-YY) Total MNSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

6 Schedule A.2- Campaign Contributors 1. ndividuals (class 1) contributing 100 or more: 2. Organizations (classes 2, 3, 4, 5, 6) contributing 100 or more: NAME ADDRESS DATE{S) {DO- MM - YY) CLASS AMOUNT :--- Total Table R1: Class of Contributors: : j. 1. ndividual 2. Corporation/Business 3. Unincorporated Organization 4. Trade Union 5. Non-Profit Organization 6. Other Contributor 3. Anonymous contributions remitted to local government: DATE RECEVED {00-MM-YY) CONTRBUTON VALUE DATE REMTED {00-MM-YY) r- Total MNSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

7 Schedule 8 - Election Expenses A. Election campaign advertising for: 1) radio, television, newspaper, periodical or electronic advertising to the public 2) signs, pamphlets, flyers and brochures 3) advertising and promotion for the public not included in A-1 or A-2 above ~--- B. Election campaign office expenses for: 1) compensation paid to persons for campaign work, other than for services described in section 89(2) of the Local Government Act (or section 62 of the Vancouver Charter) 2) rent, insurance, utilities 3) courier services and postage 4) furniture and equipment 5) office supplies and other office expenses not covered by B-1 to B-4 above _; _ C. Convention and other similar meeting expenses: D. Expenses for campaign-related functions not described in C: E. Research and polling expenses: F. Campaign-related transportation: G. Other (provide description): c G w..r,~~)i"' c.,!\,{\ b. bzl., Total amount of other expenses Total Amount of Election Expenses: ~~ MNSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET

8 Schedule C- Surplus Funds Disbursement (Candidate) A. Balance remaining in account --'----- B. Amount reimbursed to candidate from campaign account for the candidate's contribution to their campaign _: C. Amount of remaining surplus funds (after any reimbursement under B) --'----- D. Details of the disbursement of remaining surplus funds under C: -'----- Schedule C - Surplus Funds Disbursement (Campaign Organizer/ Elector Organization) A. Balance remaining in account B. Details of the disbursement of remaining surplus funds MNSTRY OF COMMUNTY, SPORT AND CULTURAL DEVELOPMENT- CAMPAGN FNANCNG STANDARD FORMS BOOKLET