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<br /> <br /> <br />DECLARATION OF INTEREST <br />Municipal Conflict of Interest Act <br /> <br /> <br />Ebwf!Tdiojefs <br />Mayor/Councillor/Committee Member Name: ___________________________ <br /> <br />Kvmz!29-!3133 <br />Date of Meeting: _______________________________________ <br /> <br />Puubxb!Tusffu!Sfhjpobm!Joufotjgjdbujpo!Dpssjeps <br />Item Title: _______________________________________ <br /> <br />ETE.3113.424 <br />Report Number (if applicable): _______________________________________ <br /> <br /> <br /> <br />(*Please circle the appropriate variable) <br /> <br />Ebwf!Tdiojefs <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 />Nz!sftjefodf!jt!dmptf!up!Puubxb!Tusffu <br />_________________________________________ <br />_________________________________________ <br />_________________________________________ <br />_________________________________________ <br />_________________________________________ <br /> <br />Mayor/Councillor/Committee Member Signature: _________________________ <br /> <br />Kvmz!29-!3133 <br />Date of Declaration: _________________________ <br /> <br /> <br />FOR OFFICE USE <br /> <br /> <br /> <br />Date received: __________________ Received by: ______________________ <br /> <br /> <br /> <br />Date entered into registry: ______________ Registry updated by: _________________ <br /> <br />