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Cityry <br /> Louisville { <br /> L:ULI,]ti/11JO'Dl1�iL:L' 19'l8 <br /> 1/31 I X <br /> City CIerit's Ounce 074 <br /> ,Zi Main street,frouis:ille,CO 61:102.i <br /> sOs-ssb-4,,5/Fon <br /> 3Ds-ssbTb50 Date aiamp <br /> Ernoil: Mercdytilm@loei;:illeco.so„ <br /> DISCLOSURE BY PUBLIC OFFICEHOLDER <br /> REPOR 1 uF GIF 15, ROMOKARIA AND II I HER BENEFITS <br /> (3ec. <br /> Filers should also review provisions of 5ecrion s,#rricre/ow of me <br /> MUNICIPAL FILING <br /> Filing required: 1'`Quarter n Lnd QuarterE jrd Quarter n 4`h Quarter <br /> taue April 171 (tlee lel 15) {ase octobcr 15) (due,anuary i ) <br /> flame of office RoI er: Susan Lao — Ward 2 <br /> Address: 102U Willow Place, Louisville CO 5027 <br /> Check one of the following: ✓ I have nothing to report(Please s:gn and date bul,w) <br /> I received the following gifts honoraria, or Benefit durins this period. <br /> 1) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 Date Received: <br /> Description: <br /> 2) Name of Person from Who the Gift. Ronoraria or Otfler Benefit Wa; Received: <br /> /Amount/value: $ Date R ceived. <br /> Description: <br /> .$) (Game os Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 Date Received <br /> Description: <br /> 4) Name of Peu,on from Who the Gift_ Honoraria or Other Benefit was Received: <br /> Amount/Value: $ uate Received: <br /> uescription: <br /> Signature/ 1/i 411114r.. i Date:, 7/2--A 1 r g <br />