Local Government Act Section 90

CITY OF NANAIMO

CAMPAIGN FINANCING DISCLOSURE STATEMENT FOR THE 2011 GENERAL ELECTION

(COUNCILLOR)

Form 3-9b

This disclosure statement is to be filed with the Manager of Legislative Services of the City of Nanaimo within 120 days after the local general election voting day (March 19, 2012). Disclosure statements may be filed from March 20th, 2012 until April 18th, 2012 on payment of a $500 late filing penalty to the City of Nanaimo.

NAME OF CANDIDATE: .8r i «1'1 f) lfMQCe NAME OF OFFICE for which the candidate sought election: ____ ..:::C:...::O::..::U=N..!.:C:::..;Ic=L=L.::::.O~R~--____,-

NAME OF ENDORSING ELECTOR ORGANIZATION (if applicable):

SUMMARY OF CAMPAIGN CONTRIBUTIONS

Total amount of campaign contributions Total of (A, B & C) from Schedule A: Part 1 (page 4)

List of contributors who made contributions totalling $100 or more Complete Schedule A: Part 2 (page 5)

Total amount of anonymous campaign contributions remitted to the City of Nanaimo

Total from Schedule A: Part 3 (page 6)

SUMMARY OF ELECTION EXPENSES

Total amount of election expenses

COMPLETE SCHEDULE B (page 7)

SURPLUS FUNDS

Transfer from local government (surplus funds from previous election)

Balance (positive or negative) remaining in candidate's campaign account

COMPLETE SCHEDULE C (page 8)

CAMPAIGN ACCOUNT INFORMATION

$ @

All monetary contributions were deposited in, and all election expenses paid from an account opened for this purpose at Ko}f! ( fM. ( located at Cot11,.fr41 t $1 , AI«JJA.,'"&:>

1 BC

(name of financial institution) (Branch address)

NOTE: This is not a balance sheet. For example, contributions may not equal expenses. COMPLETE THE APPROPRIATE DECLARATIONS ON PAGES 2 AND 3

Page 1 of 13

Form 3-9b DECLARATION OF CANDIDATE

I, 8rta.-o TcJd F( /lfl\o(e , a candidate for COUNCILLOR in the City of Nanaimo 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 discloses the information required by Section 90 .of the Local Government Act in relation to my election campaign for the office of COUNCILLOR in the 2011 local general election for the City of Nanaimo; and

(b) the requirements of Division 8- Campaign Financing of the Local Government Act have been met in relation to my election campaign for the office of COUNCILLOR in the 2011 local general election for the City of Nanaimo.

Declared before me at NCA!h.A1.J\rvCO · , British Columbia

this (Y\Mvh , 2014~

Desig ocal o ernment Officer or · Cornmissio er for taking affidavits for British Columbia

DECLARATION OF ELECTOR ORGANIZATION OFFICIAL (if applicable)

I, _________________ , being the-------,----,----,-..,.,------(title of authorized official)

for the-------,----=--=-----...,.---,--,----------' solemnly a,ffirm that to the (name of elector organization)

best of my knowledge, information and belief:

(a) this campaign financing disclosure statement and supporting schedules completely and accurately discloses the information required by Section 90 of the Local Government Act for the election campaign of ----------:----:-::---::-c:-:-:-----------

(name of candidate)

for the office of COUNCILLOR in the 2011 local general election for the City of Nanaimo; and

(b) the requirements of Division 8- Campaign Financing of the Local Government Act have been met in relation to the election campaign of--------------------for the office of COUNCILLOR in the 2011 local general election for the City of Nanaimo.

Declared before me at _________ , British Columbia

this ___ day of _________ , 201_.

Designated Local Government Officer or Commissioner for taking affidavits for British Columbia

Signature of Elector Organization Official

Page 2 of 13

Form 3-9b

DECLARATION OF CAMPAIGN ORGANIZER (ifapplicable)

I, -~---------------' being the-----::-:-:-:----=--::-----=----=---=--:--::-----(title of authorized official)

for the---------:----::--:---:------:---:-:--:----------' solemnly affirm that to the (name of elector organization)

best of my knowledge, information and belief:

(a) this campaign financing disclosure statement and supporting schedules completely and accurately discloses the information required by Section 90 of the Local Government Act for the election campaign of-----------,---,------,-,--------------

(name of candidate)

for the office of COUNCILLOR in the 2011 local general election for the City of Nanaimo; and

(b) the requirements of Division 8- Campaign Financing of the Local Government Act have been met in relation to the election campaign of---------------------for the office of COUNCILLOR in the 2011 local general election for the City of Nanaimo.

Declared before me at------~--· British Columbia

this ___ day of _________ , 201_.

Designated Local Government Officer or Commissioner for taking affidavits for British Columbia

Signature of Campaign Organizer

DECLARATION OF FINANCIAL AGENT

I, -----------------------------' have prepared this

disclosure statement and supporting schedules for-.,..,..,...,........,-----,--...,.-,---------:----:--:---name of candidate (or elector organization or campaign organizer, if applicable)

and solemnly affirm that to the best of my knowledge, information and belief that:

(a) this campaign financing disclosure statement and supporting schedules completely and accurately discloses the information required by Section 90 of the Local Government Act in relation to the election campaign of---------:----:----::-:-:--:----------

(name of candidate)

for COUNCILLOR in the 2011 local general election for the City of Nanaimo; and

(b) the requirements of Division 8- Campaign Financing of the Local Government Act have been met in relation to the election campaign of----------:----::-----:-:-:---:-------

(name of candidate)

for COUNCILLOR in the 2011 local general election for the City of Nanaimo.

Declared before me at _________ , British Columbia

this ___ day of _________ , 201 .

Designated Local Government Officer or Commissioner for taking affidavits for British Columbia

Signature of Financial Agent

Page 3 of 13

CAMPAIGN FINANCING DISCLOSURE STATEMENT CAMPAIGN CONTRIBUTIONS

SCHEDULE 'A'

PART 1: CONTRIBUTIONS

Contributions from known sources

Form 3-9b

Total value of contributions of $100 or more from a single source (A) $ 3,L.f 18. 8K Unless nil, complete Schedule A: Part 2 (page 5).

$ 3/ ..,. f)(j Total value of contributions totalling $99.99 or less from a single source (B) __ T!

Contributions from anonymous sources

Contributions from anonymous sources

LESS: value of anonymous contributions over $50 remitted to the City of Nanaimo

$ ,

(Total from Schedule A: Part 3- page 6) $ ___ _

Total value of anonymous campaign contributions of $50 or less =(C)

TOTAL VALUE OF CONTRIBUTIONS (A+ B +C)=

Total number of contributors who made contributions totalling $99.99 or less

Page 4 of 13

CAMPAIGN FINANCING DISCLOSURE STATEMENT CAMPAIGN CONTRIBUTIONS

SCHEDULE 'A'

PART 2: LIST OF CONTRIBUTORS TOTALLING $100 OR MORE from Item (A) (page 4)

*1* FULL NAME *Z* ADDRESS DATE AMOUNT (if ap_Qiicable)

Wer.Jv SmitK. ~ A/&1\ll,;.f\0 I B c JIDtJ 3 , lo ({ #1/;() Ji~ ~o/dsqcK A}Af\q,;M~ 1 'BC /lov .3 ~I ( j;t;JO

11t. ~t11561) £.1trnri5t.S L1l 'H' o;,t,·~S#I'I 1.,1 ~fzvilf! Sc , IP-A lilt/ Art JI,JfJ/1 ./Sa5

!'16$5 fi~ia f Ct!rluaHtll\ 'J.o!-155 S(illlltr -~j -IJ,..,,_·,.,~ :Rc Vtf~ ~J? J/Oll! Jt> I ( $)60 1115121 -Alhtrfa.. 1Ac.. 'ft;6- tt>rij H.~ t~;; fJrJI s.~. CQIGArv :A 'fi, 2K., 1/uv ?, )I> I f IJ~ G~r'i~ VJ:~c~ Vi/14-'e 'if :t f Allltcn>JS I,.J PIIV ll,ltJ/1 I StxJ , ; "+- tn. ft~or~ NtAM/AftJ AC V,ci/N I IJAIJJ. f. l.ob«'f Mw ~/). ?-'ftlb ~w lw{ JJ. N•n-;JM, J"c. II, . /Wb JJ11v !Lf,Jo/1

DATE

SUB-TOTAL

CAMPAIGN FINANCING DISCLOSURE STATEMENT CAMPAIGN CONTRIBUTIONS

SCHEDULE 'A'

PART 3 - LIST OF ANONYMOUS CONTRIBUTIONS OVER $50 REMITTED TO CITY OF NANAIMO

VALUE DATE

SUB-TOTAL

Form 3-9b

VALUE

'

Page 6 of 13

Local Government Act Section 90(4)(f) BC. Reg. 380/93

Form 3-9b

CAMPAIGN FINANCING DISCLOSURE STATEMENT

SCHEDULE 'B'

ELECTION EXPENSE DETAILS

A. Election campaign advertising or communication expenses for:

(1) radio, television, newspaper, magazine or electronic advertising for the public

B.

(2) signs, pamphlets, flyers and brochures

(3) advertising and promotion for the public not included in A(1) or (2) above

(4) newsletters for members of the elector organization

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

(2) rent, insurance and utilities

(3) courier services and postage

(4) ·furniture, telecommunication equipment and other equipment

$ J,Ot~

$37-2. ~8 $ -go.Do

$ 10

$ e(,

$ e $ .(£ $ R£

(5) office supplies and other office expenses not covered by B(1) to (4) above $ ___ _

C. Convention and similar meeting expenses $ ___ _

n.,... L $ ') M . t> Cl D. Expenses for campaign related functions not described in C above ~iT ~VeL

E. Research and polling expenses $ .@

F. Campaign related transportation $ ff

G. Other expenses (provide description)

9-a.rhtufs {Jromo c~ r)? $ 80,00

$ ___ _

$ ____ _

$ ___ _

Total amount of other expenses

TOTAL AMOUNT OF ELECTION EXPENSES

Page 7 of 13

Local Government Act Section 90(4)

A.

B.

C.

CAMPAIGN FINANCING DISCLOSURE STATEMENT

SCHEDULE 'C'

DETAILS OF SURPLUS FUNDS DISBURSEMENT

Balance remaining in account

Amount reimbursed to candidate from campaign account for the candidate's contributions to his/her campaign

Amount of remaining surplus funds (after any reimbursement under B.)

D. Details of the disbursement of remaining surplus funds under C.

Form 3-9b

$ kY

$ 1?/ $RL

Page 8 of 13

Form 3-9b

CAMPAIGN FINANCING RECORD KEEPING FORM

RECORD OF CASH CAMPAIGN CONTRIBUTIONS

•1.FULL NAME ·z· ADDRESS DATE AMOUNT •3.CLASS (if applicable)

TOTAL

*1* If numbered corporation or unincorporated organization, include full name of 2 individuals who are directors or principal officers or members.

*2* Do not report addresses of individuals.

*3* Classes: individual, corporation, unincorporated organization, trade union, non-profit organization, other.

Page 9 of 13

Form 3-9b

CAMPAIGN FINANCING RECORD KEEPING FORM

RECORD OF IN-KIND CAMPAIGN CONTRIBUTIONS

*1*NAME *Z* ADDRESS DATE GOOD or VALUE (if applicable) SERVICE

£Nil~-3035 8«-Ht?l\.$ _fJ.tt.. /JrH~A1 ttto .-B·c V'IT 3 '/ ~ /J,t) ; I ;lQ I ' AJvtr'f'ij'~ /)/j~IM • J;.oo ..,

I

TOTAL

Form 3-9b

CAMPAIGN FINANCING RECORD KEEPING FORM

RECORD OF DISCOUNTED GOODS AND SERVICES

GOOD OR SERVICE PRICE PAID FAIR MARKET VALUE (RETAIL VALUE)

TOTAL

Page 11 of 13

CAMPAIGN FINANCING RECORD KEEPING FORM CAMPAIGN CONTRIBUTIONS

RECORD OF ANONYMOUS CAMPAIGN CONTRIBUTIONS $50 OR LESS

Form 3-9b

CONTRIBUTION VALUE/AMOUNT DATE REMITTED TO LOCAL (MONEY, GOODS) (if greater than $50) GOVERNMENT

'

TOTAL

Page 12 of 13

Form 3-9b

CAMPAIGN FINANCING RECORD KEEPING FORM

RECORD OF ELECTION EXPENSES

GOODS, PROPERTY OR SERVICES DATE DATE AMOUNT RECEIVED INCURRED PAID

Co111pql'1 f) 5iqfl alls7rtAC.fi'~ll Sblr~~ I Pw,ll, 'Jo!l Nw 11, :01 f .f CfO. o8 v v

N~na.ltnP JJew5 i>q/le-kn (~i.r) Mov, 10, ~o /I Nov 12 ,~of/ I )'/Ob. ID £/,Y,~ J;;ttiMIJ (~~~cR. CrrJ 5

J

IJotJ. ~ j_~l f IJ()t1 M, l.t> I f I J.. ~Jrr ;..o V\.. lJ 67.2, d() W¢C,4.,f Glffi1Afli4f..tol15 ( MJPSI41) l.hv ;;.. ' .