Elections ACT

Member of the Legislative Assembly
annual return for the 2003/2004 financial year	
	This return covers the period:	/       /	to	/       /		
		1/7/03 or the date the MLA commenced as an MLA		30/6/04 or the date the MLA ceased to be an MLA		
Please refer to the Funding and financial disclosure handbook, Members of the Legislative Assembly when completing this form.	
	
The due date for lodging this return is Thursday 21 October 2004	
	
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	
	
MLA details	
			
Name of MLA:			
			
Postal address:			
	Postcode:                    		
			
Reporting agent’s details 	
			
Name of reporting agent:			
			
Postal address:			
	Postcode:                    		
			
I certify that the information contained in this return and its attachments is true and complete.	
Agent’s signature:	/          /          		
			
This form is  Approved Form AF2004-35 under section 340A of the Electoral Act 1992
	MLAs annual return - Page 2 of 3

Gifts	
	
1.  Total gifts this financial year	$		
This total includes all gifts received by the MLA in his or her capacity as an MLA.	
Importantly:	
•	the total must include all gifts received by, or on behalf of, an MLA in his or her capacity as an MLA;
•	do not include receipts of a personal nature (for example, income, salary and private gifts for personal use);
•	all transactions, including those of less than $1500, must be included in the total;
•	all figures must be gross; and
•	this total includes monetary receipts and gifts-in-kind (as defined in the Funding and financial disclosure handbook, Members of the Legislative Assembly).	
	
2.  Persons and organisations from whom $1500 or more was received	
•	In the table below, list the name, address and the total amount given by those persons and organisations from whom $1500 or more was received.
•	In determining whether the $1500 threshold has been reached, amounts of less than $1500 need not be counted.
•	Only amounts received by, or on behalf of, an MLA in his or her capacity as an MLA are to be included; do not show receipts of a personal nature (for example, income, salary and private gifts for personal use).	
	
	Name	Address	Amount received		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
	If space is insufficient please attach additional sheets		

	MLAs annual return - Page 3 of 3
	
Payments	
			
3.  Total payments this financial year	$		
•	This total includes all payments by the MLA, in his or her capacity as an MLA, for all categories of payments as defined in the Funding and financial disclosure handbook, Members of the Legislative Assembly.
•	All transactions, including those of less than $1500, must be included in the total.
•	All figures must be gross.	
	
Outstanding debts as at 30 June	
			
4.  Total debts as at 30 June	$		
•	This total includes all debts, overdrafts and unpaid accounts of the MLA, in his or her capacity as an MLA, for all categories of debts as defined in the Funding and financial disclosure handbook, Members of the Legislative Assembly.
•	All debts, including those of less than $1500, must be included in the total.
•	All figures must be gross.	
	
5.  Persons and organisations to whom $1500 or more is owed	
In the table below, list the name, address and the total amount outstanding for those persons and organisations to whom $1500 or more is owed for all categories of debts as defined in the Funding and financial disclosure handbook, Members of the Legislative Assembly.  All amounts must be included when determining if the threshold has been reached.	
	Name	Address	Amount Owed		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			$		
			
	If space is insufficient please attach additional sheets