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City0 <br /> I.()LlliSV k g3/( <br /> COLORADO•SINCE 1a78 <br /> City Clerk's Office rn <br /> /*Main 3LreeL,i:ouisville,O allaci <br /> 303-333-4a i6/Fax A!1a-aaa-waau Dote Stamp <br /> Email: I121eretlyiMIP1 Plouisvi lleco.gov <br /> Dis4EubORE BY ru6EIC UFFICEFRUEDER <br /> REPORT OF GIFTS, HONORARIA AND OTHER BENEFI i 5 <br /> (Sec.14-6-203,C.R.S.) <br /> r;r�.,,noQri3 or,o rev,err p.ovisions of Section 3,Article XXIX of rhe Colorado Constirurion <br /> IOIDIiICIPAr ririi G <br /> Filing required: 1"Quarter n 2"d Quarter= 3'°Quarter w`"Quarter <br /> (due April=aj (due July by Vlue vctofler lar (nue January by <br /> Name of Office Holder: 'ett Li■toll vvara '? <br /> Address: 6y2 1 triiiaia5k Lout t, Loui5vi11C Cu &iiJ2/ <br /> Check one of the followins: I have nothing tv report(Please,ign and date below) <br /> I receivEd the following gifts, honoraria, Pr benefit during thi, period. <br /> r.) flame or Person from vvfo the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/value: $ Date REceived: <br /> Da,cription: <br /> 2) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 Date Received: <br /> Description: <br /> s) flame of Person from vvRo die Girt, Honoraria or Dtrier Benefit Was Received: <br /> Amount/value: $ Date Receive!: <br /> De,cription: <br /> 4) Name of Person from Who the Gift, Honwraria or Other Benefit Wa, Received: <br /> Amount/Value: $ Date Received: <br /> uescription: <br /> Signature - / Date: 1%6/ 1 <br />