County Clerk Salt Lake County Clerk
Election Division
Financial Disclosure Report

Name of Candidate of Officeholder Political Party
Address City State Zip Code

Office Sought Phone Number Fax # Email Address

Org Type: Personal Campaign Committee
Report: 2009 Year End Report


Column A
Total this Period
Column B

Contributions Received
1 Total Contributions Received
(See Schedule A)
$500.00 $500.00 * - YTD totals may reflect activity from past years.
Expenditures Made
2 Total Expenditures Made
(See Schedule B)
$10.00 $10.00 * - YTD totals may reflect activity from past years.
Balance Summary
3 Balance at Beginning of Reporting Period $666.21 Refer to Line 7 on last report
4 Total Contributions Received
(From Line 1 Column A)

5 Subtotal
(Add Lines 3 and 4)

6 Total Expenditures Made
(From Line 2 Column A)

7 Balance at Close of Reporting Period $1,156.21

Schedule A
Itemized Contributions Received

Date Received Contributor
Address Occupation Employer Type Amount In-Kind?
05/05/2009 Gary Ott
Recorder Salt Lake County Individual $500.00

Total Contributions $500.00

Schedule B
Itemized Expenditures Made

Date Expended Recipient Name Purpose Amount In-Kind?
03/16/2009 Key Bank service fee $5.00
04/17/2009 Key Bank service fee $5.00

Total Expenditures $10.00