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LVuisviIk <br /> %vr.v��n►�v• <br /> al-1:Z'; Tara /450 <br /> City Clerk's Office <br /> !� <br /> .w�amain street, [ouisvihe,w sous r �I'I <br /> 3u,-33a-yard r Fax 17,J-.1 -rFaau Date S.amp <br /> Email: ICIereEydiivi@loeis-illeev.ge. <br /> DISCEOSURE BY PUBLIC OFFICEHOLDER <br /> REPORT OF GIFTS, HO11uRARIH JNIGD u i HER BEIQEFI s <br /> (Sec.24-6-203,C.R.S.) <br /> Filers should also review provisions of Section z,Firricle h7r n of the Cororauo 4onsriturion <br /> MOIGICIPHL FILING <br /> Filins required: 1'Quarter n 2"°Quarters 3`"uuarrer 0 �`h Quar.r n <br /> gCue FCpril=3r ;sue July.i [nue ictal=r b) las.JariO�.ry 15) <br /> Name of Office Molder: ij-y Keany Ward 1 <br /> Address: 1488 WilbOu Place, Louisville CO 80027 <br /> Check one of the following: II I have nothing to report(Please sign and date below) <br /> - I received the following gifts, honoraria_ or benefit during this period. <br /> it Dame of Person frv,m Who the Gift, Honoraria or Other Benefit Wa, Received: <br /> Amount/Value: 5 Date Received: <br /> Description: <br /> 2) Name of Person from Who the Gift_ Honoraria or other Benefit vvas Receives: <br /> Amount/Value: $ Date Receives: <br /> Description: <br /> 3) Mame or Person from vvno the Gift, Hon,raria or Other Benefit Was Received: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> 4) Name of Person from Who the Gift, Honoraria or Other Benefit VVdS neceivetl: <br /> Amount/Value: $ Date Received: <br /> Description: <br /> i - <br /> Signature / Date: / - 5- /2- <br />