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I: Cry, _itta <br /> Louisville kr <br /> CVL JZIJW •'SUVCL' 15 ea 1/11/(4 <br /> ///jam <br /> City CIerR's oinice <br /> 7� I ' <br /> ,4,Main street,couisville,CO 8o11e1 <br /> alla-aaa-Fra/6/rax.sDs-ads-4550 Oa Le Stamp <br /> Email: MeraaytrIM@Ivei,;illeca.5D <br /> DIscEOsORE BY PUBLIC OFFICEHOLDER <br /> REPORT OF GIF i s, FIOIQuRARIN AND u 1 REK BEI IEFI IS <br /> (Sec.2;-6-z0a,C.R.3.) <br /> Filers should also review provisions of erection a,tirticre,w, of[ne Colorado Constirution <br /> MUNICIPAL FILING <br /> Filing required: 1'Quarter' L"uuar ern 3`d Quarter Q 4th Quarter n <br /> (Eue April 13) roue July i Mo.,.tictaser 15) (sec Janaar y 15) <br /> Dame of office Molder: Susan Loo Ward 7 <br /> Address: 1020 Willow Place, Louisville CO 80027 <br /> Check one of the following: I I I have nothing to report (Please sign ansa Date Below) <br /> I received the following gifts- honoraria_ or benefit during this pedal. <br /> 1) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amc,ont/Value: 5 Date Received: <br /> Description: <br /> 2) Name of Person from Who the Gift_ honoraria or Diller Benefit was Received: <br /> Amount/value: $ Date Received: <br /> Description: <br /> i) (Came or Person from WhC,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_ Honoraria or Other Benefit vvas Received: <br /> Amount/Value: $ Date Receiver: <br /> Description: <br /> Signature %, , Or • ° Date: 1-72/Lt/ /2e5 r 7 <br />