Thompson-Nicola Regional District CANDIDATE CAMPAIGN FINANCING DISCLOSURE STATEMENT

Transcription

1 .', - ~.. '.- '.,'..'.. Thompson-Nicola Regional District CANDIDATE Form No Section 90 PLEASE PRINT DEADLINE FOR SUBMISSION This disclosure statement is to be filed with the ClerkDirector of Community Services of the Thompson-Nicola Regional District within 120 days after general voting day (Monday, March 19,2012). NOTE: This document will be made available for public inspection at the Thompson-Nicola Regional District Office during regular office hours and on the Thompson-Nicola Regional District website. ~ VIm &ILJ~ fireit lfl i I Candidate's Full Name Office for which candidate sought election NIt Name of endorsing Elector Organization (if applicable) Name of ea:jt:targanizer (if appliceble) SUMMARY OF CAMPAIGN CONTRIBUTIONS Total amount of campaign contributions (Total from Part 1, Schedule A) 0 List of contributors who made contributions totalling 100 or more (see Part 2 of Schedule A) Total amount of anonymous campaign contributions remitted to the Thompson-Nicola 0 Regional District (Total from Part 3 of Schedule A) SUMMARY OF ELECTION EXPENSES Total amount of election expenses (Total from Schedule B) <6 SURPLUS FUNDS Transfer from local government (surplus funds from previous election, if applicable) 0 Balance (positive or negative) remaining in candidate's campaign account () Disbursement of surplus funds, please complete Schedule C CAMPAIGN ACCOUNT INFORMATION All monetary contributions were deposited in, and all election expenses paid from an account opened for this purpose at NIA- Located at iva- Name of Financiallnsfitution Branch Address NOTE: This is not a balance sheet. For example, contributions may not equal expenses. COMPLETE THE DECLARATION(S} ON THE REVERSE Page 1 of 7

2 DECLARATION OF CANDIDATE I, lflnj rjaj2.aj T"l Candidate's Full Name a candidate in the Thompson-Nicola Regional District election, solemnly affirm that to the best of my knowledge, information and belief: (a) (b) this campaign financing disclosure statement and supporting schedules completely and accurately discloses the information required by section ~O of the in relation to my election campaign for the office of Director of Electoral Area L-- in the 2011 Local Government Election for the Thompson-Nicola Regional District; and the requirements of Division 8 - Campaign Financing of the Local ternment Act have been met in relation to my election campaign for the office of Director of Electoral Area in the 2011 Local Government Election for the Thompson-Nicola Regional District. Declared before me at British Columbia this KfrfVJLoOP? q r-... day of J1;+-I2e.I=f-,2011,",,"~" Chief Election Officer, 0 aking affidavits for British Columbia DECLARATION I, for OF FINANCIAL AGENT have prepared this ~s6losure statement and Financial Agent's Full Name supporting SCh~jeS an~~t:2~ffirm that to the best of my Candidate's Full Name kno,,,e, information and belief that: (a) this campaign financing disclosure statement and supporting :hedules completely and accurately discloses the information required by section 90 of the Local Governme Act in relation to the election campaign of Candidate's Full Name for the office of Director of Electoral Area the 2011 Local Government Election for the Thompson-Nicola Regional District; and in (b) the requirements of Division 8 - Campa" the election campaign of n Financing of the have been met in relation to rj I fr' for the office of Director of Electoral Area the 2011 Local Government Election for the Thompson-Nicola Regional District. in Declared before me at,.." British Columbia this day of,2011 Signature of Financial Agent Chief Elect{on Officer, or a Commissioner for taking affidavits for British Columbia Page 2 of 7

3 SCHEDULE A TO COMPAIGN CONTRIBUTIONS PART 1 - CONTRIBUTIONS Contributions from known sources Total value of contributions of 1 00 or more from a single source (unless nil, complete Part 2) Total value of contributions totalling or less from a single source Contributions from anonymous sources ;V 11-4' Total value of contributions from anonymous sources B LESS: total value of anonymous contributions over remitted to the Thompson-Nicola Region District (Total from Part 3 of Schedule Total value of anonymous campaign conjidutions of 50 or less Total amount of contributions ' = -+ C A+B+C = Total number of contrib tors who made contributions totalling or less Page 3 of 7

4 ~ - SCHEDULE A TO -- COMPAIGN CONTRIBUTIONS PART 2 - LIST OF CONTRIBUTORS TOTALLING 100 OR MORE (Line A) Important! If you are attaching a supplementary list, check this box: 0 FULL NAME 1 ADDRESS (if required)2 DATE RECEIVED AMOUNT CLASS 3, " V ~ tl ' _ 1. If numbered corporation or unincorporated organization, include full name of 2 individuals who are directors or principle officers or members. 2. Do not report addresses of individuals. 3. Classes: individual, corporation, unincorporated organization, trade union, non-profit organization, other. Page 4 of 7

5 Section 90(4)(b) SCHEDULE A TO COMPAIGN CONTRIBUTIONS PART 3 - LIST OF ANONYMOUS CONTRIBUTIONS OVER 50 REMITTED TO THE THOMPSON-NICOLA REGIONAL DISTRICT Important! If you are attaching a supplementary list, check this box: 0 DATE RECEIVED VALUE DATE RECEIVED VALUE...~ \ \ ~., ;, ' SUBTOTAL: A SUBTOTAL: B TOTAL ( A + B ) Campaign Financing Disclosure Statement For Candidate Section 90(4 )(f) Page 5 of 7

6 B.C. Reg ', -SCHEDUL.E B TO '. ELECTION EXPENSE DETAilS A. Election campaign advertising or communication expenses for: (1) Radio, television, newspaper, periodical or electronic advertising for the public (2) signs, pamphlets, flyers and brochures 95CJ. ::5<t (3) advertising and promotion for the public not included in A (1) or (2) above (4) newsletters for members of the elector organization 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 (2) rent, insurance and utilities (3) courier services and postage (4) furniture, telecommunication equipment and other equipment (5) office supplies and other office expenses not covered by B (1) to (4) above C. Convention and similar meeting expenses: D. Expenses for campaign related functions not described in C above E. Research and polling expenses - Campaign related transportation G. Other expenses (provide description): Total amount of other expenses: TOTAL AMOUNT OF ELECTION EXPENSES c9- so.sg Campaign Financing Disclosure Statem~nt For Candidate Section 90(4) Page 6 of?

7 SCHEDULE C TO DETAILS OF SURPLUS FUNDS DISBURSEMENT A. Balance remaining in account < B. Amount reimbursed to candidate from campaign account for the candidate's. contributions to hislher campaign C. Amount of remaining surplus funds (after any reimbursement under B.) D. Details of the disbursement of remaining surplus funds under C. Page 7 of 7