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
School Board

Org Type: Local School Boards
Report: June 15, 2010 Interim Report for School Board


Column A
Total this Period
Column B

Contributions Received
1 Total Contributions Received
(See Schedule A)
$250.00 $250.00 * - YTD totals may reflect activity from past years.
Expenditures Made
2 Total Expenditures Made
(See Schedule B)
$41.93 $41.93 * - YTD totals may reflect activity from past years.
Balance Summary
3 Balance at Beginning of Reporting Period $0.00 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 $208.07

Schedule A
Itemized Contributions Received

Date Received Contributor
Address Occupation Employer Type Amount In-Kind?
03/15/2010 Will Carlson
Prosecutor Salt Lake City Individual $100.00
04/22/2010 Kyle V. Costa
Stationer Tabula Rasa Individual $50.00
04/26/2010 Jon Jepsen
Insurance Sentry West Individual $100.00

Total Contributions $250.00

Schedule B
Itemized Expenditures Made

Date Expended Recipient Name Purpose Amount In-Kind?
03/15/2010 Salt Lake County Clerk Filing Fee $25.00
03/29/2010 GoDaddy.Com Domain Registration $16.93

Total Expenditures $41.93