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BUSINESS ENTITIES: List below the name, rotation, and oature of activities of any husioess entity with <br /> holdings of real or personal properly or with business dealings in Boulder County, in which you have aoy <br /> interest, and the nature of the interest. <br /> Name and Location of Nature of the Business Nature of lnterest <br /> Business <br /> EROE RTY: List the address and location of aoy real property within Boulder Couoty in which you have en <br /> interest or. if you have a controlling interest in an entity or enterprise disclosed above, the address and <br /> location of real property in which such entity or enterprise hes en inferecf. <br /> Address and Location of Property nwoer 0f Record <br /> oDDIIInNAL INFORMATION:Add below any additional information you wish to disclose. <br /> SWORN STATEMENT: /� C' Ca yn =4 <br /> I hereby swear or affirm under penalty of perjury that.to the hest of my knowledge, information and belief, <br /> the in_f_m^atinn prn_vided in this disclosure statement is accurate and complete. I acknowledge that for the <br /> purposes of sections 5-9 and 5-10 of the Code of Ethics(regarding standards of conduct and disclos'ire), I <br /> am deemed to have an interest in my own financial affairs and in the financial affairs of my spouse or other <br /> relatives ac specified in the Code of Ethics, and that I must disclose such interests pursuant to Section 5-10 <br /> and comply with the non-participation provisions thereof, I further acknowledge that it is a violation of the <br /> Code^_f Bthir'c t0 fail to file the ctet_meot within the time required in the Code of Ethics. <br /> ,4 t7< " <br /> Ceo date/ln unbent Mature Date <br />