2022 Mayor and Council DisclosuresDISCLOSURE STATEMENT OF PERSONAL OR FINANCIAL INTEREST
Park City Municipal Corporation elected and appointed officers and employees (including volunteer
board/commission/committee members) must disclose actual or potential conflicts of interest between their
personal interests and public duties. This is required by the Municipal Officers' and Employees' Ethics Act, Utah
Code section 10-3-1301 et. seq, and the Municipal Code of Park City Disclosure; Conflicts of Financial Interest,
section 3-2. (Type or print all information.)
I,______________________________(name),______________________________ (position) am an appointed
officer, elected officer, or employee of Park City Municipal Corporation and make this statement of interests:
A.Are you employed by; are you an officer, director, or agent of; or do you own an interest in any Business
Entity (sole proprietorship, partnership, association, joint venture, corporation, firm, trust, foundation, or other
organization or entity used in carrying on a business)?
පzĞƐ Ƒ No
B.Select any category that applies:
ප/ƌĞĐĞŝǀĞŽƌŚĂǀĞĂŐƌĞĞĚƚŽƌĞĐĞŝǀĞĐŽŵƉĞŶƐĂƚŝon for assisting a person or Business Entity in a transaction with
Park City.
ප/ (this includes your spouse or your minor children) am an officer, director, agent, employee or the owner of a
substantial interest (at least 10%) in a Business Entity that is subject to regulation by Park City. If the value of the
interest does not exceed $2,000, do not check this box.
ප/ (this includes your spouse or your minor children) am an officer, director, agent, employee or owner of a
substantial interest (at least 10%) in a Business Entity that does or anticipates doing business with Park City.
ප/have a personal interest or investment which creates a conflict with my public duties.
පEŽŶĞŽĨƚŚĞĂďŽǀĞĐĂƚĞŐŽƌŝĞƐĂƉƉůLJ͘
C.If you identified any actual or potential conflicts above:
______________________________________________________________________________
Appointed officer, elected officer, or employee’s address.
Name of the business entity (where interest is at least 10%).
Status, relationship, or commitment to the Business Entity or person named above.
Address and phone number of the Business Entity or person named above.
D. Give a detailed description of the actual or potential conflicts of interest identified above, including the
nature of the relationship of each Business Entity or person with the City. Use more sheets if necessary. (This
disclosure statement will not be accepted as valid unless this section is completed.)
I declare under criminal penalty under the law of Utah that the foregoing is true and correct.
Signed on the _____ day of __________,_______, at _____________________________________.
Date Month zĞĂƌ City or other location, and state or country
________________________ ________________________
Printed name Signature
This statement is a public document and the information is required to be provided to the Mayor. It must be filed
with the immediate supervisor of an appointed officer or employee or with the Mayor if a member of the City
Council. Members of boards/commissions/committees must file with the assigned staff member.
This statement must be filed when the potential or actual conflict arises and updated if the position changes
significantly or if the value of the interest in the entity increases significantly since the last disclosure.
Ƒ Immediate supervisor reviewed on ______________ (date)