Annual Disclosure Reports 2017 - Laserfiche WebLink

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BUSINESS ENTITIES: List below the name, location, and nature of activities of any business entity with holdings of real or personal property or with business dealings in Boulder County, in which you have any interest, and the nature of the interest. Name and Location of Nature of the Business Nature of Interest Business dD twke 111.1111111 PROPERTY: List the address and location of any real property within Boulder County in which you have an interest or, if you have a controlling interest in an entity or enterprise disclosed above,the address and location of real property in which such entity or enterprise has an interest. Address and Location of Property Owner of Record ADDITIONAL INFORMATION:Add below any additional information you wish to disclose. SWORN STATEMENT: I hereby swear or affirm under penalty of perjury that, to the best of my knowledge, information and belief, the information provided in this disclosure statement is accurate and complete. I acknowledge that for the purposes of Sections 5-9 and 5-10 of the Code of Ethics(regarding standards of conduct and disclosure), I am deemed to have an interest in my own financial affairs and in the financial affairs of my spouse or other relatives as specified in the Code of Ethics, and that I must disclose such interests pursuant to Section 5-10 and comply with the non-participation provisions thereof. I further acknowledge that it is a violation of the Code of Ethics to fail to file the statement within the time required in the Code of Ethics. 4-oct, rg)11' I Candidate/Incumbent i nature Date