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ITEChyli <br /> 1. ul ill <br /> v 5v C <br /> COLORADO•SINCE .878 43/1Y <br /> city Clerk's office Y <br /> fr6 7ireet,Louisville,Cu auGL/ <br /> 3U3-337-47/D/ Fax Ai-333-437Q date bum, <br /> Email: MerellytillV1@Iouisvilleco.gov <br /> DI5CE0sORE By rOBEIC OFFILEFIUCQER <br /> REPORT OF GIFTS, HONORARIA AND OTHER BENEFITS <br /> (Sec. C.R.S.) <br /> Km's SI10ola v1S0,ev;eev,.rovisions of Section 3,Article XXIX of rhe Col ado Consrirurion <br /> 10101QICIFAr rlE•119G <br /> Filing required: 1"Quarter n 2"d Quarter= 3'd Quarter I 41"Quarter n <br /> (due April 13) (Due July Nue octaler 13) (Due January 1nl <br /> Name of Office Holder: Susan Lou ______ vvarB 7 _ <br /> Address: 102U Willow place, Louisville UU 80027 <br /> Check one of the following: I have nothing to report(Please sign and date below) <br /> I received the following sifts, honoraria, or benefit during this period. <br /> 1) Name of Person from Who the Gift, Honoraria or Other B;rnefit Was Received: <br /> Amount/value: $ Date Received: <br /> Description: <br /> 2) Name of Person from Who the Gift, Honoraria or Other Benefit Was Received: <br /> Amount/Value: 5 Date Received: <br /> Description: <br /> 3) Mame of Person from vvflo the Gift, Flonoraria or tidier Benefit Was Received: <br /> Amount/value: $ Date Receivea: <br /> Descriptiun: <br /> 4) Name of Person from Who the Gift, Honoraria or Other Benefit Wa, Received: <br /> Amount/Valuu: 5 Date Received: <br /> Description: <br /> Signature /ice ,��(.(e�411, !i Date: /O 3 .2a <br />