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Liz eityry // - <br /> Louisvilvle <br /> Alet..utrime LJ •auI t 1Hra <br /> City CIerR's Orme <br /> roti main 3treer,Eouisville,CO 3000z i <br /> .30s- 1 5/6/Fa,7. 1:1i-JJS-15s0 nate Stamp <br /> Email: MereOytRlMM@keisrilleco.be <br /> DISCLOSURE BY PUBLIC OFFICEHOLDER <br /> REPORT OF GIF 1 s, HiiNURAKIA AND O i HER BENEFITS <br /> ( ec.zy-3-03,Cita.) <br /> Filers should also review provisions of aecrion 3,.'rricre AMA of me Coro,pao co....r.T..C.,. <br /> MUNICIPAL FILING <br /> Filing required: 1"Quarter � uuar[er= s`d Quarter n 4th Quarter n <br /> ;'aue April 15; (Ifue Jely b) (bee Octo5=. 15) (due January 1 ) <br /> Name of office Raider: Jett Lipton Ward- 2 <br /> Address: 692 lamaiisK(Ault, Louisville CU 80027 <br /> Check one of the following: have nothing t0 report(Please sign and date below) <br /> I received the following gifts_ honoraria, or Benefit durine thi3 period. <br /> 1) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 DdLe Received: <br /> Description: <br /> 2) Name of Person from Who the Gift_ Ronoraria or Otller Benefit Wa, Received: <br /> Hmount/Value: $ Date Received: <br /> Description: <br /> .3) Mame of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 Date Received: <br /> Description: <br /> 4) Name of Person from Who the Gift_ Honordria or Other Benefit was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> Signature Date: 4 7 <br /> 7 <br />