Election Sign Deposit Application

In accordance with Section 6 of the Election Sign By-law 76-2018, a refundable security deposit shall be paid to the Town prior to the placement of any Election Signs. Election Signs removed by the Town in accordance with the By-law are subject to a sign removal fee of $20.00 per sign which shall be deducted from the applicable security deposit.

This application form and the payment of the security deposit must be completed before the placement of any Election Signs.

Please Note: The election sign deposit should be reflected on your Financial Statement.

To arrange for any accessibility needs or to request this form in an alternate format, please contact elections@kingsville.ca or 519-733-2305 ext. 500.

Type of Candidate

Please select the appropriate category:

Mayoral Candidate - $140.00

Deputy Mayoral Candidate - $140.00

Councillor Candidate - $140.00

Trustee Candidate - $140.00

Registered Third Party - $140.00

Federal/Provincial Candidate - $300.00

Candidate/Registered Third Party Information

First Name

Last Name

Street Address

Town

Province

Postal Code

Email Address (a copy of this form will be emailed to you)

Phone Number

Contact Person Information

Is the contact person the same as above?

Yes

No

Declaration

I, the undersigned, do hereby confirm and attest that:

I am paying the Election Sign Deposit which entitles me to place Election Signs in the Town of Kingsville, as prescribed in the Election Sign By-law 76-2018.

I have read and will abide by the provisions of the Election Sign By-law 76-2018 and am responsible for the placement and display of all my Election Signs.

I understand that any contraventions of the Election Sign By-law 76-2018 will be deducted from the acquired Election Sign Deposit.

I understand that if contraventions exceed the acquired Election Sign Deposit, I will be issued an invoice and shall have five (5) days after notice is received to pay the outstanding balance.

I understand Election Sign penalties/deductions are a personal responsibility of the candidate and will not be included on my Financial Statement.

Signature of Candidate/Registered Third Party or Authorized Agent

Clear

Privacy Statement: Personal information of this form is collected under the authority of the Town of Kingsville Election Sign By-law 76-2018. The information will be used to administer the collected of required fees. This form will be available for public inspection in the Clerk's Office. Questions about the collection of this information can be directed to the Clerk of the Town of Kingsville, 2021 Division Road North, Kingsville, ON N9Y 2Y9, Telephone: 519-733-2305.

Election Sign Deposit Application

Type of Candidate

Candidate/Registered Third Party Information

Contact Person Information

Declaration

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