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Cityrf <br /> Louisville 417511� <br /> COLORADO.SINCE 1878 111 ffi <br /> City Clerk's Office <br /> /49 Main Street,Louisville,CO 80027 <br /> 303-335-4536/Fax 303-335-4J30 Email: Dot=St.mi., <br /> MeredyihM@loulsvilleco.gov <br /> DISCLOSURE BY POBEIC OFFICEROWER <br /> REPOR I OF GIFTS, HONORARIA AND OTHER BENEFITS <br /> (sec. -5-L0 ,C.R.S.) <br /> i-hers snouza ors.roP:.,.rv7.�.v,— XXIX of the Colorado Constitution <br /> MUNICIPAL FILM <br /> Filing requires: 1s Qaurter 11 2"d Quarters 3'd Quarter I I rF`"uuarter n <br /> (au c 461 15) Woe July 15) (due,,ctober (clue January 1st <br /> Name of Office Holder: Jay Keany vvara 1 <br /> Haoress: 143z5 vvilaon ?incr., Louis vale CU 80027 <br /> Check one of elle following: I have nothine to report (Please Sign and date below) <br /> I received the followirl6 gifts, honoraria, or benefit during this period. <br /> 1) Name of Person from vvho the Gifthonoraria or Oiler Benefit Wa; Received: <br /> Amount/value: $ Date Receiv;d: <br /> De,zription: <br /> z) flame of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 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 /> qr) flame of Person from wRo tRe Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> Signature _ Date: <br />