Amended di closure for an Elected Member or Candidate

The information on this onn is collected under the Election Funding, E)cpenditure and Disclosures Act 7981 and will be made publicly available,

Elected Member or Candidate details

This amendment appEes t th. disclosure of political donations and electoral expenditure for (tick which appliesI

12^" Candidate (State or Local Government). Elected Member (SI e MP or Local Government Counc"10/1Mayor)

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DISCLOSURE PERIOD COM ENCES

" ^I. elected mornb. r of riot appoint an official agent then they are deemed to be their own official agent and must complete this section.

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Slantha, the amendmen supplied won omitted urineorredly declared in the original disclosure of political donations and dentoralexpendlturelodged with"'10 NanEC and that the donations and orexperidltu, e specified elected member or candidate during tie dtsclosuie period. understandlhat giving information whichl knowiS false or do notieasonabty believe is true, is an offence.

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, JULY 20.5

I. ^,,^AUorron FULL NAME

a) I was given full aid free access at all reasonable times to all accounts and doeriments of the agent responsible for lodging the declaration and of the elected member or candidate relating dlreclly or indirectlyto any matter requied to be disclosed under Part 6 of the Beetfon Funding, Expenditure and Disclosures Act 7987;

by I duly examined such of hose accounts and documents asl considered material forthe purposes o19Mng this certificate;c) I roc. Ived all Inform!, lion and explanations that I asked for with respect to any matter required to be set out in the declaration, subject to the qiamcations 111 any) specified in this certificate; and

ELECroRAL DISTRICTOR LOCALGOVERNME, ,rrAREA

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Relevant disclosure period

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SIG, ,IATURE OF AUDrTOR

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Certificate of a registered company auditor (to be completed by the auditor)

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DISCLOSURE PERIOD ENDS

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30 JUNE 2016

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REGISTRATION No.

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certify that

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Disclose here any amend ents to personal funds contributed by the elected member or candidate during the relevant disclosure period

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Note: Self funding announ

Disclose here any amend ents to smallpoliticaldonations made to or for the benefit of the elected member or candidate during the relevant disclosure period.

TOTAL NUMBER OF SMALL CLITICAL DONAhONS RECEIVED

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TOTAL NUMBER OF SMALL OLmCAL DONATIONS RECEIVED

s are not required to be disclosed again on the form as donations received.

Disclose here any amend ents toreportable political donations made to or forthe benefit of the elected member or candidate during the relevant disclosure period.

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FD. 703 Page 2 of 8

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Part Di: Event details fundraising function(SI orventure(SI.Disclose here any amen merits to fundraising functions or ventures held by or on behalf of the elected member or candidate during the relevant disclosure period.

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Part 02: Small politicalDisclose here any amen

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on ations received at fundraising function(SI or venture(SI.merits to small political donations made to Dr forthe benefit of the elected member or candidate as part of any fundraising function orventure during the relevant disclosure period.

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Part DB: Reportable pol ticaldonations received at fundraising function(SI or venttiretSI.Disclose here any amend entsto reportable political donations made to or forthe benefit of the elected member or candidate as part of any fundraising junction or venture during the relevant disclosure period.

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New South Wales Electoral Commission I GPO Box 4046, Sydney NSW 2001 I Tel: 1300 02201, I Fax: (02) 9290 5410 I Email: Idc@elections. msw. gov. au I WWW. electtons. new. gov. au

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Note: The gross total of Part 01 must equal the sum of totals 02 and 03 TOTAL

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FD. 703 Page 3 of 8

Disclose here any amendmentsto reportable loans madeto orforthe benefit of the elected member or candidate during the relevant disclosure pertod. This includes any prior period loans that have yet to be repaid...... -,,,, .,.. ,... .. a=. =. ..... . '., ,.. ...,,., ., , , ,..,, , =.. ..

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Part F1: Expenditure on advertisements in radio, television, internet, cinemas, newspapers, billboards, posters, brochures, how-to-vote cards and other election material.Disclose here any amendments to electoral communication expenditure incurred by the eleded member or candidate with respect to advertisements durlng the relevant disclosure period.,.= .

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New South Wales Electoral Commission I GPO Box 4046. Sydney NSW 2001 I Tat 1300 022 011 I Fax: (02) 9290 5410 I Email: Idc@elections. rig\v. gov. au I vrww. elections. nsw. gov. au

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FD. 703 Page 4 of 8

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Part F2: Expenditure on the production and distribution of electoral materials.Disclose here any amend ants to electoral communication expenditureincurred by the elected member or candidate with respect to the production and distribullon of election material during the relevant disclosure period.

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Part F3: Expenditure on them tomet, telecommunications, stationery and postage.

""ninja -- -- - - --- -- -- - - - ---- - gala ^-.---Disclose here any amendments to electoral communication expenditureincurced by the elected member or candidate with respect to the internet, telecommunications. stationery or postage during the relevantdisclosure period.

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New South Wales Electoral Commission I GPO Box 4046. Sydney NSW 2001 I Tel: 1300 022 011 I Fax: (02) 9290 5410 I Email: Ideaelec!;crispsw. gov. au ! unrw. elections. nsw. gov. auon ''' ' co co or' ,'' in""" on ne '. an. mar . . co mus*", w. Ovau un, WE co tone. s . u

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FD. 703 Page 5 of B

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Parr F4: Expendittireincurred employing staff engaged in election campaigns.Disclose here any amend 'ents to electoral communication expendhureInnurred by the elected member orcandidate with respect to employing staff engagedin election campaigns during the relevant disclosure period.

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Part F5; Expenditure incurred for office accommodation for staff and candidates.Disclose here any amend ' ents to electoral communication expendltureincurred by the elected member or candidate with respect to office accommodation for staff and candidates (other than campaignheadquarters of a party o^electorate office of an elected memberI during the relevant disclosure period.

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New South Waits Electoral c minission I GPO Box 4046. Sydney NSW 2001 I Tel: tan0 022 011 I Fax: (02) 9290 5410 I Email:Idc@elections. nsw. gov. au I WWW. elec!ions. msv, .gov. au

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FD. 703 Page 6 of B

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Parr F6: Expenditure inc rred on travel and travel accommodation for candidates and staff engaged in electoral campaigning.Disclose here any amend enls to electoral communication expenditure incurred by the elected member or candidate on travel and itavel accommodation for candidates and staff engaged in electoral campaigningduring the relevant disclos re period.

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Part 1.72 Expenditure incDisclose here any amend ents to electoral communication expenditure incurred by the elected member or candidate on research associaled with election campaigns during the relevant disclosure period.

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rred on research associated with election campaigns 10ther than in-house research).

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New South Wales Electoral Commission I GPO Box 4046. Sydney NSW 2001 I Tel: 1300 022 017 I Fax: 102192905410 I Emaa: Ideaelectlonsnsw. gov. au I WWW. dealor, s. nsvJ. gov. au

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FD. 703 Page 7 o18

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Disclose here any amend ents to other items of electoral expenditure incurred by the elected member or candidate during the relevant dlsclosure period (not already disclosed under Parts F1-Fn

Total expenditure incurre in raising funds for an electbn

Total expenditure incurred in auditing campaign accounts

Tbtal other electoral expo di!ure

DisciDse here any amendments to small politica! donations made by the elected member or candidate during the relevant disclosure period to another NSW candidate. group, of candidates, local governmentcouncillor member of parliament, political party or third-party campaigner ,IT~ ' I^,,_ ,TOTAL NUMBER OF SMALL OLITICAL DONATIONS MADE

Disclose here any amend eats to reportable political donations made by the elected member or candidate during the relevant disclosure period to another NSW candidate. group of cand. idates, local governmentcouncillor member of parlement, poit. ical party or ,hird-party campaigner

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If more space is require please go to the NSWEC website and download an additional spreadsheet.Amendment Legend: Cm I an item = O Add a new item = AOnce completed, please Tint, sign and forward to the New South Wales Electoral Commission.

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FD. 703 Page a of 8

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