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) I <br />1KiTCHE-N----ER <br />DECLARATION OF INTEREST <br />Municipal Conflict of Interest Act <br />_ f <br />Mayor/Councillor/Committee Member Name: .. <br />Date of Meeting: Loirl 15 a ci� ► <br />Item Title: <br />Report Number (if applicable): <br />w 2n/L '` <br />V <br />(*Please circle the appropriate variable) <br />I, Mayo 1 Councillor' Committee* member <br />declare t t kbelie that I have a direct / indirect* pecuniary int6rest 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: 11 ?0 -qLf <br />0-gLf „V6 <br />I 1 <br />�`•�� , Qom/ ,4 j"It <br />LlA UA'� <br />C.f a�T.ro-rh <br />\Jv19. V 2 <br />Mayor/Councillor/Committee Member Signature: <br />Date of Declaration- <br />FOR OFFICE USE <br />Date received:�/ 6, go %q <br />Received by: jac /u n <br />Date entered into registry: ftp!51 171 aDI ( Registry updated by: 'ZrO' <br />