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DECLARATION OF INTEREST
Municipal Conflict of Interest Act
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Mayon ouncHlgrAl-ommittee
Date of Meeting:
Item Title:
Report Number (if applicable)
Member Name: �aLA� S .�
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(*Please circle the appropriate variable)
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I, Mayqr I Councillor,PCommittee* member a-�Aj
declareat'TUe— eve that I have a direct / indirect* pecunia ` interest as
defined in the Municipal Conflict of Interest Act related to the above
topic/item found on the Council/Committee agenda for the following
reason:
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Mayor/Councillor/Committee Member Signature:
Date of Declaration:
FOR OFFICE USE
Date received: &� 13. 2z 1Received by: z-.4 b t-,
Date entered into registry: MOL,4 ;aQJ9_ Registry updated by: -r?3 -