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111 Citytr <br /> Louisville <br /> col.()RA1)(:)•SI\C1 I' 'r <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: is`Quarter 2nd Quarter.. 3rd Quarter n 4th Quarter n <br /> (due April 15) (due July 15) (due October 15) (due January 15) <br /> Name of Office Holder: Jeff Lipton Ward 2 <br /> Address: 692 Tamarisk Court, Louisville CO 80027 <br /> Check one of the following: "V 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 /> _241Lif <br /> Signature rte/ Date: <br />