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Page of REPORT OF CONTRIBUTIONS FOR AMOUNTS $750.00 OR GREATER (Please remember to include these contributions on the next required report for accounting purposes.) Name of Candidate Address Ogden, UT Candidate for: Council Member – Municipal Ward 1 Council Member – Municipal Ward 3 Council Member – At-Large Seat A Council Member – At-Large Seat B For contributions received on or between August 8, 2017 and August 14, 2017 I, , as Candidate/ Secretary of the aforesaid personal campaign committee, that all contributions and expenditures not heretofore reported have been reported; and that there are no bills or obligations outstanding and unpaid except as set forth in the report. Signature of Candidate/Secretary of Committee DATE RECEIVED NAME COMPLETE ADDRESS* AMOUNT PURPOSE TOTAL *Complete address required (Attach additional sheets if necessary)