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1 <br />Krrc:�;�R <br />DECLARATION OF INTEREST <br />Municipal Conflict of Interest Act <br />F - <br />Mayor/Councillor/Committee N <br />Date of Meeting: <br />Item Title: <br />Report Number (if applicable) <br />(*Please circle the appropriate variable) <br />, Mayor / Councillor / Committee* member y1u, " ) .) /" <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 />Mayor/Councillor/Committee Member Signature:' <br />a <br />Date of Declaration: 4 �,u <br />t <br />r I <br />FOR OFFICE USE <br />Date received: a A R /1 -9 <br />Date entered into registry: <br />Received by: I Y) r) <br />Registry updated by: <br />11 � <br />