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K�TMcHiF,NER <br />DECLARATION OF INTEREST <br />Municipal Conflict of Interest Act <br />Mayor/Councillor/Committee Member Name: --<A V,, <br />Date of Meeting:u u ark p2o <br />Item Title: <br />Report Number (if applicable) <br />(*Please circle the appropriate variable) <br />�L)4 <br />I, Mayor / Councillor / Committee* member <br />declare that I believe that I have a direct / indirect* pecuniary interest as <br />defined in the Municipal Conflict of Interest Act related to the above <br />topic/item found on the Council/Committee agenda for the following <br />reason: <br />OLA..) PN Wo � r <br />I <br />Mayor/Councillor/Committee Member Signature: <br />M <br />Date of Declaration: '-` <br />Date received: <br />FOR OFFICE USE <br />Received by: <br />Date entered into registry: Registry updated by: <br />