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REPORT DUE DATE: August 8, 2017 (by 5:00 p.m.) REPORT OF CONTRIBUTIONS & EXPENDITURES FOR CANDIDATES 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 and expenditures made from first contribution or expenditure to August 5, 2017. 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.) State of Utah) County of ) Subscribed and sworn to before me by on this day of 2017. Notary Public § ---PAGE BREAK--- REPORT DUE DATE: August 8, 2017 (by 5:00 p.m.) CANDIDATE CAMPAIGN FINANCIAL STATEMENT SUMMARY SHEET 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 TOTALS 1 Balance carried forward from last report. (Summary of contributions, expenditures, loans & debts reported in previously filed financial statement.) $ 2 Aggregate total of all contributions of $50 or less during this reporting period. (From the table in Attachment $ 3 Total of contributions from donors who gave more than $50 during this reporting period. (From the table in Attachment A – names, addresses, dates & amounts need to be included on the attachment.) $ 4 Total contributions as of this report. (Add lines 2 and $ 5 Total expenditures made or obligations incurred during this reporting period. (From the table in Attachment B – names, addresses, dates, amounts & purposes need to be included on the attachment.) $ 6 BALANCE AT THE END OF REPORTING PERIOD. (Add lines 1 and 4, then deduct line 5 for the balance.) $ ---PAGE BREAK--- REPORT DUE DATE: August 8, 2017 (by 5:00 p.m.) Attachment A CONTRIBUTIONS RECEIVED Name of Candidate 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. Total of all contributions of $50 or less received from any individual since the last report. $ Total of all contributions in excess of $50 including in-kind contributions. (Please list the date received, name and address of the contributor, the amount received, and the purpose of the contribution on the reverse side of this form.) $ ---PAGE BREAK--- REPORT DUE DATE: August 8, 2017 (by 5:00 p.m.) CONTRIBUTIONS RECEIVED DATE RECEIVED NAME COMPLETE ADDRESS AMOUNT PURPOSE TOTAL (Attach additional sheets if necessary) ---PAGE BREAK--- REPORT DUE DATE: August 8, 2017 (by 5:00 p.m.) Attachment B CAMPAIGN EXPENDITURES Name of Candidate Expenditure means: 1. A purchase, payment, donation, distribution, loan, advance, deposit, gift of money or anything of value made for the purpose of influencing the nomination or election of any candidate. 2. A contract to make any expenditure. 3. A transfer of funds by a candidate or a personal campaign committee to another candidate, another candidate’s personal campaign committee or a political committee. 4. Goods or services provided to or for the benefit of another candidate, another candidate’s personal campaign committee, or a political committee for political purposes at less than fair market value. 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. DATE OF EXPENDITURE PERSON/ORGANIZATION TO WHOM DISBURSEMENT WAS MADE COMPLETE ADDRESS AMOUNT PURPOSE OF EXPENDITURE TOTAL (Attach additional sheets if necessary)