Elections ACT

Election return of electoral expenditure
by a third party	
following the ACT Legislative Assembly election held on	Insert date of ACT election		
			
Please refer to the Funding and financial disclosure handbook, Third parties when completing this form.	
	
The due date for lodging this return is [insert date 15 weeks after polling day]
(15 weeks after polling day)	
	
Enquiries and returns should be addressed to:

ACT Electoral Commission
PO Box 272
CIVIC SQUARE ACT 2608	
Telephone: 6205 0224	Fax: 6205 0382	Email: elections@act.gov.au	Website: www.elections.act.gov.au	
Third party details	
			
Name of person or organisation incurring expenditure:			
			
Postal address of person or organisation incurring expenditure:			
	Postcode:                    		
			
Details of person completing the return	
			
Full name of person completing the return:			
			
Capacity/position of person completing the return:			
			
(A return for an organisation should be signed by an appropriate officer, such as the company secretary or finance manager.  See the Funding and financial disclosure handbook, Third parties for details.)	
			
Postal address of person completing the return:			
	Postcode:                    		
			
Contact telephone:			
			
I certify that the information contained in this return and its attachments is true and complete.	
Agent’s signature:	/          /          		
			
This form is  Approved Form AF2004-30 under section 340A of the Electoral Act 1992
	Election return of electoral expenditure by a third party - Page 2 of 2
	
Electoral expenditure	
	
This return covers the period:	10/9/2004	to	16/10/2004		
Set out the total expenditure incurred by, or on behalf of, the third party during the pre-election period in the categories identified below.	
Note:	
•	no disclosure needs to be made if the total electoral expenditure is less than $1500;	
	
•	only the listed categories of expenditure are to be disclosed (for example, travel costs are not included);	
	
•	only include expenditure incurred on goods used or services provided in the categories listed below during the pre-election period (10 September 2004 to 16 October 2004);	
	
•	expenditure on campaign goods or services used during the pre-election period must be included irrespective of when payment was actually made (for example, the cost of production incurred before the pre-election period of advertisements shown during the campaign period); and	
	
•	all figures must be gross.	
				
	Categories of electoral expenditure	Amount Paid		
	Broadcasting electoral advertisements (including production costs)	$		
	Publishing electoral advertisements (including production costs)	$		
	Displaying electoral advertisements at a theatre or other place of entertainment (including production costs)	$		
	Production of printed electoral matter requiring authorisation (for example, how-to-vote cards, posters and pamphlets)	$		
	Producing and distributing electoral matter addressed to particular persons or organisations (such as direct mailing, including printing and postage)	$		
	Consultant’s or advertising agent’s fees in respect of services provided or material used relating to the election	$		
	Opinion polling and other electoral research	$