HomeMy WebLinkAbout18- Gift Disclosure Form - A. Surratt - Crowley Fleck Mug BO9
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City of Bozeman
P.O.Box 1230/121 North Rouse Avenue
Bozeman,Montana
agenda@bozeman.net
59771
Phone:406-582-2320
Fax:406-582-2344
Gift Disclosure Form www.bozeman.net
Date:
Name: r r \
Department: G ��
Phone#:
Email address: (ZS-Ury�Lc, 6D7_e_� P�A4
Who gave the item? t C S dcynwfell T4
For what purpose? �
Describe the Item:
What is the Items Estimated Value? 5
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:
In van rh c
By submitting this form,you are confirming that the information contained erein is correct and true to the best of your
knowledge. A digital signature can be created through the'submit by e-m it button.If you lj� fer,you can also rint sign
and mail or deliver to the clerk's office. Thank you!
Signature:
If you have questions about the gift provision please call or e-mail the City Attorney at(406)582-2309.