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4K <br />KJTC.HE-,-N-­ER <br /><--Nw-r <br />DECLARATION OF INTEREST <br />Municipal Conflict of Interest Act <br />f�r� <br />Mayon ouncHlgrAl-ommittee <br />Date of Meeting: <br />Item Title: <br />Report Number (if applicable) <br />Member Name: �aLA� S .� <br />�u <br />f <br />(*Please circle the appropriate variable) <br />., o . ac1) —0 ® In <br />I, Mayqr I Councillor,PCommittee* member a-�Aj <br />declareat'TUe— eve that I have a direct / indirect* pecunia ` 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 />(!" j w I/ V <br />Mayor/Councillor/Committee Member Signature: <br />Date of Declaration: <br />FOR OFFICE USE <br />Date received: &� 13. 2z 1Received by: z-.4 b t-, <br />Date entered into registry: MOL,4 ;aQJ9_ Registry updated by: -r?3 - <br />