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, _, <br /> 1: ityty r iceLull.u5vtile f } <br /> c,.„.„7,,,,,,,,7•3ts�Ci tti/t 11 <br /> I <br /> City Clerk's Office <br /> fws main Street,i ouisville,CO 300c/ <br /> Fax/ Fax 303-35-=F330 Gate Stamp <br /> Email: ,v,eretlyi11101@Iouis:ill.ev.so. <br /> DISCWsORE BY PUBLIC OFFICEHOLDER <br /> REPORT OF GIFTS, Huiv RHRIA AND u HER BEIVEFI i 5 <br /> (Sec.24-6-203,C.R.S.) <br /> Ki.-,s should also review provisions of Section 3,Krricre AA1A of me Colorado Consr:r.r:—.. <br /> r <br /> MOIQICIPAL FILING <br /> Filin%required: 1"Quarter El 2""Quarter= Std Quarter = 4th Quarter n <br /> • (due April 13) lEue July 13i (see Octefe. is) (dew Jonoc r 15) <br /> 1 Name of Office Holder: Lhiistuphet Leh Ward 1 <br /> Address: 414 walnut Laic, Louisville Ci.i 8uO2i <br /> Check one of the following: R I have nothing to report(Please sign aria nate Below) <br /> I received the following gifts_ honoraria_ or benefit during Cis period. <br /> 4 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, Honoraria or Other Benefit was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> 3) Name of Person from Milo 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 nenefit vvas Receiver]: 1 <br /> Amount/Value: $ Date Receives: 1 <br /> Description: <br /> Signature .-rr- / •/ -" Date: a6 oc-,Q..2 <br /> , <br />