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City,y- <br /> Louisville (�, <br /> 'l <br /> 6-0/ <br /> elk <br /> City Clerk's Office <br /> 749 Main Street, Louisville,CO 80027 <br /> 303-335-4576/Fax 303-335-4550 Date Stamp <br /> Email: MeredythM@louisvilleco.gov <br /> DISCLOSURE BY PUBLIC OFFICEHOLDER <br /> REPORT OF GIFTS, HONORARIA AND OTHER BENEFITS <br /> (Sec.24-6-203,C.R.S.) <br /> Filers should also review provisions of Section 3,Article XXIX of the Colorado Constitution <br /> MUNICIPAL FILING <br /> Filing required: 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter n <br /> (due April 15) (due July 15) (due October 15) (due January 15) <br /> Name of Office Holder: Jay Keany Ward 1 <br /> Address: 1488 Wilson Place, Louisville CO 80027 <br /> Check one of the following: ...>< I have nothing to report (Please sign and date below) <br /> I received the following gifts, honoraria, or benefit during this period. <br /> 1) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> 2) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> 3) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> 4) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> Signature /�v' " Date: 7-5- <br />