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: Year-End 2010 Summary Report


Column A
Total this Period
Column B

Contributions Received
1 Total Contributions Received
(See Schedule A)
$111.27 $19,836.39 * - YTD totals may reflect activity from past years.
Expenditures Made
2 Total Expenditures Made
(See Schedule B)
$440.00 $29,866.43 * - YTD totals may reflect activity from past years.
Balance Summary
3 Balance at Beginning of Reporting Period $10,451.09 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 $10,122.36

Schedule A
Itemized Contributions Received

Date Received Contributor
Address Occupation Employer Type Amount In-Kind?
11/01/2010 K.S. Lewis

Individual $100.00
12/31/2010 America First Account Dividend P.O. Box 9199
Ogden, Ut 84409
N/a N/A Organization $11.27

Total Contributions $111.27

Schedule B
Itemized Expenditures Made

Date Expended Recipient Name Purpose Amount In-Kind?
10/30/2010 Jeff Morton Sign Placement $100.00
11/02/2010 Lohra Miller Campaign Election Room Rental $100.00
11/29/2010 Ricardo Hernandez sign distribution & pick-up $240.00

Total Expenditures $440.00