CANDIDATE NOMINATION PACKAGE C2 - Nomination Documents PLEASE PRINT IN BLOCK LETTERS JURISDICTION N AM E (E.G. MUNICIPALITY, REGIONAL DISTRICT ELECTORAL AREA) CITY OF NANAIMO We, the follow ing electors o f the above named jurisdiction, hereby nom inate: NOMINEE'S LAST NAME FIRST NAM E fY l c M IDDLE NAME(S) i t USUAL NAME OF PERSON NOM IN ATED IF DIFFERENT FROM ABOVE AN D PREFERRED B Y W yF E PERSON i N O M IN A TE D TO APPEAR ON THE BALLOT RESIDENTIAL ADDRESS (STREET ADDRESS) C ITY/TOW N U k~>J4 vSS M AILING ADDRESS IF DIFFERENT FROM RESIDENTIAL ADDRESS (STREET ADDRESS/PO BOX NUMBER) POSTAL CODE rV w 0 \J‘ i T C ITY/TOW N POSTAL CODE As a Candidate fo r the office of: POSITION (E.G. MAYOR, COUNCILLOR, DIRECTOR) JURISDICTION NAM E (E.G. MUNICIPALITY, REGIONAL DISTRICT ELECTORAL AREA) CITY OF NANAIMO Each o f us affirms th a t to the best o f our knowledge, the above named person nominated fo r office: 1. Is or w ill be on general voting day fo r the election, 18 years o f age o r older. 2. Is a Canadian citizen. 3. Has been a resident o f British Columbia, as determ ined in accordance w ith section 52 o f the Local Government Act, fo r the past six m onths im m ediately preceding today's date. 4. Is not disqualified under the Local Government Act, or any o ther enactm ent from being nominated for, being elected to o r holding the office, or is not otherwise disqualified by law. 5. Is not subject to any o f the disqualifications set o u t in section 66(2) o f the Local Government Act. NOM INATO R'S NAM E (FIRST, MIDDLE AN D LAST NAMES) NOM IN ATO R'S NAM E (FIRST, MIDDLE AN D LAST NAMES) RESIDENTIAL ADDRESS (C ITY/TO W N, STREET ADDRESS, POSTAL CODE) IF N O M IN A TIN G AS A R ESIDENT ELECTOR IF N O M IN A T IN G AS A RESIDENT ELECTOR PROPERTY ADDRESS (C IT Y /fO W N , STREET ADDRESS, POSTAL CQJJEl IF N O M IN A TIN G AS A NON-RESIDENT PROPERTY ELECTOR PROPERTY ADDRES£-(€JTY/TOW IF N O M IN A T IN G ^ A NON-I Z RESID E N TIAL AD DRESS ( C I T Y / T O W N ^ r jE E T ADDRESS, PO STAL CODE) z ? ,, EET ADDRESS, POSTAL CODE) PROPERTY ELECTOR . ^ . N t jM I NATO R'S S1G NAT URI I consent to the above nom ination fo r office: NOMINEE'S IOMJNE SIGNATURE ORIGINAL - C ity o f N a n a im o PLEASE KEEP A COPY FOR YOUR RECORDS DATE: (Y Y Y Y / M M / DD) C2 - P a g e 1 o f 2 This f o r m is a v a ila b le fo r p u b lic in s p e c t io n CANDIDATE NOMINATION PACKAGE C2 - Nomination Documents PLEASE PRINT IN BLOCK LETTERS I do solem nly declare as follows: 1. I am qualified under section 66 o f the Local Government A ct to be nom inated, elected and to hold the office o f P O S IT IO N (E.G . M A Y O R , C O U N C ILLO R , DIRECTOR) _______________________________________________ fV) 2. I am o r w ill be on general voting day fo r the election, 18 years o f age or older. 3. l a m a Canadian citizen. 4. I have been a resident o f British Columbia, as determ ined in accordance w ith section 52 o f the Local G overnm ent Act, fo r the past six m onths im m ediately preceding today's date. 5. I am in no way disqualified by the Local Government Act, or any other enactm ent from being nom inated for, being elected to or holding the office, or be otherwise disqualified by law. 6. To th e best o f my knowledge, the inform ation provided in these nom ination documents is true. 7. I fu lly intend to accept the office if elected. 8. I am aware o f and understand the requirem ents and restrictions o f the Local Elections Campaign Financing A ct and I fu lly intend to com ply w ith those requirem ents and restrictions. N O M IN E E 'S SIG N A TU R E xs --------------- ---DECLARED BEFORE M E : CHIEF ELEC TKiN OFFICER OR C O M M IS S IO N E R FOR T A K IN G A F FID A V IT S FOR BRITISH C O L U M B IA D C e ti A T : (L O C A T IO N ) , D A TE: (YYYY / M M / D D ) QCj g o 1 have appointed as my Financial Agent ] 1am acting as my own Financial Agent N O M IN E E 'S S IG N ATU R E ORIGINAL - C ity o f N a n a im o PLEASE KEEP A COPY FOR YOUR RECORDS F IN A N C IA L A G E N T 'S N A M E (IF APPLICABLE) C2 - P a g e 2 o f 2 T h is f o r m is a v a i l a b l e f o r p u b l i c i n s p e c t i o n db Statement of Disclosure B ritish COLUMBIA Financial Disclosure Act You must complete a Statement of Disclosure form if you are: a nominee for election to provincial or local governm ent office*, as a school trustee or as a director of a francophone education authority an elected local governm ent official an elected school trustee, or a director of a francophone education authority an employee designated by a local government, a francophone education authority or the board o f a school district a public employee designated by the Lieutenant G overnor in Council *(’’local governm ent” includes municipalities, regional districts and the Islands Trust) Form and Fact Sheets: This form, Statement o f Disclosure, can be found on the B.C. Government W eb site: www.gov.bc.ca [type 'Statement o f Disclosure’ in the search bar]. The form can be printed and completed by hand, or it can be completed at your computer then printed. If you do complete the form at your computer, you will not be able to save it so please ensure you have printed the completed form before exiting the program. There are also important fact sheets on the Financial Disclosure A ct to accompany this form on the Web site: • Fact Sheet for those accepting nomination as a municipal official [type ‘AG 04003-a’ in the search bar] • Fact Sheet for those accepting nomination as m em ber of the Legislative Assem bly in B.C. [type ‘AG 04003-b’ in the search bar]. Who has access to the information on this form? The Financial D isclosure A ct requires you to disclose assets, liabilities and sources o f income. Under section 6 (1) of the Act, statements o f disclosure filed by nominees or municipal officials are available for public inspection during normal business hours. Statements filed by designated employees are not routinely available for public inspection. If you have questions about this form, please contact your solicitor or your political party’s legal counsel. What is a trustee? - s. 5 (2) In the following questions the term "trustee" does not mean school trustee or Islands Trust trustee. Under the Financial Disclosure A ct a trustee: holds a share in a corporation or an interest in land for your benefit, or is liable under the Income Tax A ct (Canada) to pay income tax on income received on the share or land interest has an agreem ent entitling him or her to acquire an interest in land for your benefit Person making disclosure: tv tVdu-SAS,d, R , firs t Street, rural route, post office box: r Province: City: Level of governm ent th at applies to you: Postal Code: □ provincial □ local government □ school board/francophone education authority I f sections do not provide enough space, attach a separate sheet to continue. Assets s. - s. 3 (a) List the name of each corporation in which you hold one or more shares, including shares held by a trustee on your behalf: Liabilities - s. 3 (e) List all creditors to whom you owe a debt. Do not include residential property debt (mortgage, lease or agreement for sale), money borrowed for household or personal living expenses, or any assets you hold in trust for another person: creditor's name(s) creditor's address(es) I ■................................... Incom e - s. 3 (b -d ) List each o f the businesses and organizations from which you receive financial remuneration for your services and identify your capacity as owner, part-owner, employee, trustee, partner or other (e.g. director of a company or society). Provincial nominees and designated employees must list all sources of income in the province. Local governm ent officials, school board officials, francophone education authority directors and designated em ployees must list only income sources within the regional district that includes the municipality, local trust area or school district for which the official is elected or nominated, or where the employee holds the designated position ty y o u r capacity Real Property name(s) o f business(es)/organization(s) - s. 3 (f) List the legal description and address of all land in which you, or a trustee acting on your behalf, own an interest or have an agreem ent which entitles you to obtain an interest. Do not include your personal residence. Provincial nominees and designated employees must list all applicable land holdings in the province Local government officials, school board officials, francophone education authority directors and designated employees must list only applicable land holdings within the regional district that includes the municipality, local trust area or school district for which the official is elected or nominated, or where the employee holds the designated position legal description(s) address(es) 1 Corporate Assets - s. 5 Do you individually, o r together with your spouse, child, brother, sister, m other or father, own shares in a corporation which total more than 30% o f vojgs for electing directors? (Include shares held by a trustee on your behalf, but not shares you hold by way of security.) i no *fy e s I f yes, please lis t the fo llo w in g in fo rm a tio n below & continue on a separate sheet as necessary: the name of each corporation and all of its subsidiaries in general terms, the type of business the corporation and its subsidiaries normally conduct a description and address o f land in which the corporation, its subsidiaries or a trustee acting for the corporation, own an interest, or have an agreem ent entitling any of them to acquire an interest a list o f creditors of the corporation, including its subsidiaries. You need not include debts o f less than $5,000 payable in 90 days a list o f any other corporations in which the corporation, including its subsidiaries or trustees acting for them, holds one o r more shares. s ig n a tu re 'o f person m a k in g disclosure date ocjl Im Where to send this completed disclosure form: ❖ L o c al g o v e rn m e n t o ffic ia ls : . . . to y o u r lo c a l ch ie f election office r • with your nomination papers, and . . . to the o ffic e r responsible fo r corporate adm inistration • between the 1st and 15th of January of each year you hold office, and • by the 15th o f the month after you leave office ❖ S c h o o l b o a rd tru s te e s / F ra n c o p h o n e E d u c a tio n A u th o rity d ire c to rs : . . . to the secretary treasurer o r ch ie f executive officer o f the authority • with your nomination papers, and • between the 1st and 15th of January of each year you hold office, and • by the 15th o f the month after you leave office ❖ N o m in e e s fo r p ro v in c ia l o ffic e : " with your nomination papers. If elected you will be advised of further disclosure requirements under the M em bers' Conflict o f Interest Act. ❖ D e s ig n a te d E m p lo y e e s : . . . to the appropriate disclosure clerk (local governm ent o ffice r responsible fo r corporate adm inistration, secretary treasurer, o r Clerk o f the Legislative Assembly) • by the 15th o f the month you become a designated employee, and • between the 1st and 15th of January of each year you are employed, and • by the 15th o f the month after you leave your position UAG04003 01/2004 Roger Allan McKinnon Statement of Disclosure-Financial Disclosure Act Assets - S 3 (a) Quad Development Ltd. Roger McKinnon & Associates Ltd. Oh Spa Corp. R&R Resort Group Ltd. Old House Village Development Ltd. McClair Investments Ltd. Island Daily Deals Ltd. Executive ID Web Club Inc. 20 Under 40 Awards Corp. 0769771 BC Ltd. The Sign Man Signs Ltd. In c o m e - S 3 (b-d) Quad Development Ltd. - Owner Roger McKinnon & Associates Ltd. - Part Owner Oh Spa Corp. - Part Owner R&R Resort Group Ltd. - Part Owner Old House Village Development Ltd. - Part Owner 0769771 BC Ltd. - Part Owner The Sign Man Signs Ltd. - Part Owner Roger Allan McKinnon Statement of Disclosure-Financial Disclosure Act C orporate Assets S 5 Quad Development Ltd. Type o f Business: Real Estate Holding company Land Holdings: 1. 316D - 1 3 7 6 Lynburn Place, Victoria, BC 2. #305A - 1 8 0 0 Riverside Lane, Courtenay, BC Creditors: HSBC, 101-6551 Aulds Road, Nanaimo, BC Roger McKinnon & Associates Ltd. Type o f Business: Real Estate holdings and consulting Land Holdings: 1. #305D - 1 8 0 0 Riverside Lane, Courtenay, BC Creditors: HSBC, 101-6551 Aulds Road, Nanaimo, BC O ther Corp. holdings: Subsidiaries: 20 Under 40 Awards Corp. Type o f Business: Com m unity Award Recognition Programs fo r Entrepreneurs under 40 O ther Corp. holdings: None 0769771 BC Ltd. Type o f Business: Holding company Land Holdings: 5270 Tebo Avenue, Port Alberni Other Corp. holdings: None Oh Spa Corp. Type o f Business: Resort & Destination Spa Land Holdings: S L # 9 ,1730 Riverside Lane, Courtenay, BC Creditors: Business Developm ent Bank, 500- 6581 Aulds Road, Nanaimo, BC O ther Corp. holdings: None R&R Resort Group Ltd. Type o f Business: Land Holdings: Various strata lots - 1 7 3 0 Riverside Lane, Courtenay, BC Creditors: None O ther Corp. holdings: None Old House Village Development Ltd. Type o f Business: Hotel Development Company Land Holdings: Various strata lots - 1 7 3 0 Riverside Lane, Courtenay, BC Creditors: HSBC, Roger McKinnon, Robert Fuller, Nancy McKinnon, Christopher Radomski, Sandra Tetzlaff, Binit Sadhra, Christopher & Hazel Harris, Golden Head Ventures Inc., Raldu & Ranjit Dhaiiwal, M inhas Sayani. O ther Corp. holdings: None McClair Investments Ltd. Type o f Business: Inactive (form ally held property at 1351 Estevan Road, Nanaimo, BC) Land Holdings: none Creditors: none The Sign Man Signs Ltd. Type o f Business: Sign Company Creditors: TD Canada Trust, 5777 Turner Rd, Nanaimo, BC V9T 6L8
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