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<br />I swear or verify, under penalty of perjury, that to the best of my <br />knowledge, information, and belief, I have provided, accurately and <br />completely, all of the information required by this form. I <br />acknowledge that, according to the City of Louisville Code, Chapter <br />2.80, I am deemed to have an interest in the financial affairs of <br />my spouse, other relatives, and other entities as specified in said <br />chapter. I understand that I must disclose such an interest when <br />required by said chapter. I acknowledge that it is a violation of <br />said chapter to fail to file this form within the time required by <br />said chapter. <br /> <br />Signed: <br /> <br />Date: <br /> <br />27\ 142 <br /> <br />Form date: July 13, 1992 <br /> <br />Page 4 of 4 <br />