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REPORT DUE: September 4, 2017 (by 5:00 p.m.) 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 Street Address City of Ogden, Weber County, Utah, Zip Code 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 by 5:00 p.m. REPORT VERIFICATION (Due with each report) I, , as Candidate/ Secretary of Campaign Committee of the aforesaid personal campaign committee, being duly sworn, say the foregoing is a full and true statement of account of all contributions made or received by the committee, and of the disposition thereof made and all liabilities incurred by the committee, to my knowledge; and 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 (Must be signed in front of a Notary.) Subscribed and sworn to before me by on this day of 2017. Notary Public ---PAGE BREAK--- REPORT DUE: September 4, 2017 (by 5:00 p.m.) CONTRIBUTIONS RECEIVED (Please remember to include these contributions on the next required report for accounting purposes.) Name of Candidate For contributions received on or between August 8, 2017 and August 14, 2017 by 5:00 p.m. Contribution means: 1. A gift, subscription, donation, unpaid or partially unpaid loan, advance, or deposit of money or anything of value. 2. A contract to make a contribution. 3. A transfer of funds from a political committee, a party committee, another candidate, an officeholder, or a personal campaign committee to a candidate or a candidate’s personal campaign committee. 4. A payment for the personal services of another person by a person other than the candidate’s personal campaign committee for services rendered to the candidate or such candidate’s personal campaign committee. 5. Goods or services provided at less than fair market value to or for the benefit of a candidate or a candidate’s personal campaign committee. Contribution does not mean: 1. Personal services provided without compensation by individuals volunteering their time on behalf of a candidate or such candidate’s personal campaign committee. 2. A loan of money by a national or state bank or financial institution made in accordance with the applicable banking laws and regulations and in the ordinary course of the business. NOTE: The name of a person required to be reported shall include: in the case of a natural person, the first and last name of the person; in the case of an organization, the legal name of the organization or common name by which the organization is known to the general public or its clients. The address of a person shall include: the physical street address at which the person resides or does business or at which its chief administrative or financial officer resides or does business, or the mailing address of the person at which the person commonly receives its mail. Any address reported pursuant to this shall be a complete address with sufficient information required by the US Postal Service to accomplish mail delivery to the address. ---PAGE BREAK--- REPORT DUE: September 4, 2017 (by 5:00 p.m.) CONTRIBUTIONS RECEIVED For contributions received on or between August 8, 2017 and August 14, 2017 by 5:00 p.m. DATE RECEIVED NAME COMPLETE ADDRESS AMOUNT PURPOSE TOTAL (Attach additional sheets if necessary)