DISCLOSURE CERTIFICATION AND ACKNOWLEDGMENT

I hereby submit this Disclosure Statement in accordance with the provisions of the Utah County Officers and Employee Disclosure Act set forth at Utah Code Ann. § 17-16A, et seq., as amended, and in compliance with Duchesne County Personnel Policy, for the purpose of disclosing actual or potential conflicts of interest which exist or may arise between my public duties and my personal interests. I understand and agree to submit an updated Statement when my personal, financial or employment interests change or when any potential conflicts arise. As an officer of a public body of Duchesne County, I agree to disclose the information contained herein or any other relevant information in open meeting to the members of the body prior to any discussion of items which raise or may raise potential conflicts of interest. As an employee or appointed officer, I agree to disclose the information contained herein or any other relevant information to my immediate supervisor and any other county officer or employee who may rely upon my representations in evaluating or approving any transaction of the Duchesne County.