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1l: Lity,y <br /> Louisville AI <br /> 1, ��CM1.0ItIUv•aervCL: 'Btu city Merit's Dice <br /> iati Plain ireer,rouisville,CO 8004t <br /> sus-ss -zW6/Fa;s0s-sss-Is50 Email: Date Stamp <br /> lleretlytlin@Ioei;:li.eo.goY <br /> DISCLOSURE BY PUBLIC OFFICEHOLDER <br /> REPORT OF GIF 15, RUNURAKIIA AND 0 i HER BENEFITS <br /> (sec.44-3-z03,C.11.3.) <br /> Filers should also review provisions of aecrion s,Hrric,e AAM ohne Coco..M7 M7,.,[:r..t:17.. <br /> . MUNICIPAL FILING <br /> Filing required: 1"Quarter t coo Quarter) 5rd Quarter 0 <br /> ie Quarter <br /> (clue April 131 (flue Jely 1 ) (Bet OrtoE -15) (due January i ) <br /> Name of Office folder: Susan Loo — Ward <br /> Addresb: 102U Willow Place, Louisville CO aa/2i <br /> Check one of the following: have nothing to report(Please sign and date bElow) <br /> I <br /> 7I received the following gifts_ honoraria, or Benefit durin5 this period. <br /> 1) Dame of Peron 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 Diller Benerit Was Received: <br /> Amount/value: $ Date Received: <br /> Description: <br /> .3) Dame of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 Date Received: <br /> Description: <br /> 4) Name of Person from Who the Gift, Honoraria or Other Benefit was necei�ed: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> Signature, Date: 41 3 --2,Z_ <br />