Current Officeholder Conflict of Interest Disclosure Form

Annual Conflict of Interest Disclosure

Utah Code § 17-70-304
Name*

First NameLast Name
Email*
example@example.com
Each of my current employers and my employers during the preceding year:
Name of Employer*
Address of Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Occupation and/or Job Title*
Description of the Employment*
I have more than one employer to list.
How many employers are you currently employed by and have been employed by during the preceding year?
Name of 2nd Employer*
Address of Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Occupation and/or Job Title*
Description of the Employment*
Name of 3rd Employer*
Address of Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Occupation and/or Job Title*
Description of the Employment*
Name of 4th Employer*
Address of Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Occupation and/or Job Title*
Description of the Employment*
Name of 5th Employer*
Address of Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Occupation and/or Job Title*
Description of the Employment*
Please provide the following information for additional employers: Name of the Employer, Address of the Employer, Your Occupation and/or Job Title, and a Description of the Employment*
This form is due to the Salt Lake County Clerk no later than February 2^nd, 2026 (for current office holders) or prior to submitting your declaration of candidacy.

saltlakecounty.gov/clerk/elections/disclosures
N/A FIELD

Each entity in which I am an owner or officer, or was an owner or officer during the preceding year:
This does not apply to me.
Name of the Entity*
My Position in the Entity*
Description of the Type of Business or Activity Conducted by the Entity*
I have more than one entity to list.
How many entities are you an owner or officer, or were an owner or officer during the preceding year?
Name of the 2nd Entity*
My Position in the Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 3rd Entity*
My Position in the Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 4th Entity*
My Position in the Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 5th Entity*
My Position in the Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Please provide the following information for additional entities in which you are an owner or officer, or were an owner or officer during the preceding year: Name of the Entity, Your Position in the Entity, and Description of the Type of Business or Activity Conducted by the Entity.*

Each individual from whom, or entity from which, I have received $5,000 or more in income during the preceding year (if I provide goods or services to multiple customers or clients as part of a business or a licensed profession, I am only required to provide this information as it relates to the entity or practice through which I provide the goods or services, and am not required to provide this information as it relates to my individual customers or clients):
This does not apply to me.
Name of the Individual or Entity*
Description of the Type of Business or Activity Conducted by the Individual or Entity*
I have more than one individual or entity to list.
How many individuals or entities have you received $5,000 or more in income from during the preceding year?
Name of the 2nd Individual or Entity*
Description of the Type of Business or Activity Conducted by the Individual or Entity*
Name of the 3rd Individual or Entity*
Description of the Type of Business or Activity Conducted by the Individual or Entity*
Name of the 4th Individual or Entity*
Description of the Type of Business or Activity Conducted by the Individual or Entity*
Name of the 5th Individual or Entity*
Description of the Type of Business or Activity Conducted by the Individual or Entity*
Please provide the following information for additional individuals or entities you have received $5,000 or more in income from during the preceding year: Name of the Individual or Entity and a Description of the Type of Business or Activity Conducted by the Individual or Entity.*

Each entity in which I hold any stocks or bonds having a fair market value of $5,000 or more as of the date of this disclosure form or during the preceding year, but excluding funds that are managed by a third party, including blind trusts, managed investment accounts, and mutual funds:
This does not apply to me.
Name of the Entity*
Description of the Type of Business or Activity Conducted by the Entity*
I have more than one entity to list.
How many entities do you hold stocks or bonds having a fair market value of $5,000 or more as of the date of this disclosure form or during the preceding year?*
Name of the 2nd Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 3rd Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 4th Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 5th Entity*
Description of the Type of Business or Activity Conducted by the Entity*
Please provide the following information for additional entities you hold stocks or bonds having a fair market value of $5,000 or more as of the date of this disclosure form or during the preceding year: Name of the Entity and a Description of the Type of Business or Activity Conducted by the Entity*

Each entity not listed on the previous pages in which I currently serve, or served in the preceding year, in a paid leadership capacity or in a paid or unpaid position on a board of directors:
This does not apply to me.
Name of the Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
I have more than one entity or organization to list.
How many entities do you currently serve or served during the preceding year in a paid leadership capacity or in a paid or unpaid position on a board of directors?*
Name of the 2nd Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 3rd Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 4th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 5th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 6th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 7th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 8th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 9th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 10th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 11th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 12th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 13th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 14th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Name of the 15th Entity or Organization*
Type of Position I Hold/Held*
Description of the Type of Business or Activity Conducted by the Entity*
Please provide the following information for additional entities or organizations: Name of the Entity or Organization, Type of Position You Hold/Held, and Description of the Type of Business or Activity Conducted by the Entity*

Real property in which I hold an ownership or other financial interest that I believe may constitute a conflict of interest (optional):
Description of Real Property
Description of the Type of Interest Held in the Property
I have more than one property to list.
How many real properties do you hold an ownership or other financial interest in that you believe may constitute a conflict of interest?
Description of 2nd Real Property
Description of the Type of Interest Held in the Property
Description of 3rd Real Property
Description of the Type of Interest Held in the Property
Please provide the following information for additional real properties you hold an ownership or other financial interest in that you believe may constitute a conflict of interest: Description of the Real Property and Description of the Type of Interest Held in the Property.

Name of my spouse:
I do not have a spouse.
Full Name of Spouse*
Each of my spouse’s current employers and employers during the preceding year:
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My spouse has more than one current employer or employers during the preceding year.
How many employers does your spouse currently have or had during the preceding year?
Name of 2nd Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of 3rd Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide the following for Each of your spouse’s current employers and employers during the preceding year: Name of Employer and Address of Employer.
Name of and brief description of the employment and occupation of each adult who:

a) resides in my household; and

b) is not related to me by blood or marriage:
Full Name of 1st Adult Residing in Your Household
Description of Employment or Occupation
There is more than one adult residing in my household who is not related by blood or marriage.
How many adults reside in your household who are not related by blood or marriage?
Full Name of 2nd Adult Residing in Your Household
Description of Employment or Occupation
Full Name of 3rd Adult Residing in Your Household
Description of Employment or Occupation
Full Name of 4th Adult Residing in Your Household
Description of Employment or Occupation

Description of any other matter or interest that I believe may constitute a conflict of interest (optional):
Description

Signature*

Clear
Date*

MonthDayYear
Date
This form is due to the Salt Lake County Clerk no later than February 2^nd, 2026 (for current office holders) or prior to submitting your declaration of candidacy.

saltlakecounty.gov/clerk/elections/disclosures
Contact Us

www.slco.vote | vote@saltlakecounty.gov | (385) 468-7400
Should be Empty:

Annual Conflict of Interest Disclosure