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LAST DAY TO SUBMIT: October 16, 2017 (by 5:00 p.m.) DECLARATION OF CANDIDACY FOR WRITE-IN CANDIDATES of (Print name exactly as it is to be printed on the official ballot.) I, , declare my intention of becoming a candidate for the office of: Council Member – Municipal Ward 1 Council Member – Municipal Ward 3 Council Member – At-Large Seat A Council Member – At-Large Seat I do solemnly swear that: I will meet the qualifications to hold the office, both legally and constitutionally, if selected; I reside at , City of Ogden, Weber County, Utah, Zip Code , telephone number ; I will not knowingly violate any law governing campaigns and elections; I will file all campaign financial disclosure reports as required by law; and I understand that failure to do so will result in my disqualification as a candidate for this office and removal of my name from the ballot. The mailing address that I designate for receiving official election notices is . Website Email address Alt. phone (home/work/cell) Signature (Must be signed in front of Notary.) Date State of Utah) County of ) Subscribed and sworn to before me by on this day of 2017. Notary Public §