HomeMy WebLinkAbout18- Gift Disclosure Form - C. Andrus - Pewter Pin DO
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Submit by Email Print Form
City of Bozeman
P.O.Box 1230/121 North Rouse Avenue
Bozeman,Montana
agenda@bozeman.net
59771
Phone:406-582-2320
-582-2344
Gift Disclosure Form ww.b zeman.ne
www.bozeman.net
Date: I 1,5
Name: fvL,�-/
Department:
Phone#: LIDO• 17 0v
Email address: k-vt OA.3 @ �c3LGlna.v� ��
Who gave the item? O-C- , A41
For what purpose? 1�-hoy� \ oc-t
Describe the Item: I C' .}/ `), �O�1 � IA Lk
What is the Items Estimated Value? 7
Have you reviewed the Gift Provision on page 10 of the City of Bozeman Ethics
Handbook to verify this is an item you can receive? Drop-down List
Comments:
By submitting this form,you are confirming that the information con er in is rrect and true to the best of your
knowledge. A digital signature can be created through the'sub it by e-mail'b .If you prefer,you can also print,sign
and mail or deliver to the clerk's office. Thank you!
Signature:
If you have questions about the gift provision please call 6r e ail the City Atto ey at(406)582-2309.