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ELECTED SPECIAL MUNICIPAL EMPLOYEE BOX#1 I am an elected special municipal employee. STATEMENT#1: 1 had a financial interest in a contract made by a municipal agency before I was elected to a compensated special municipal employee position. I will continue to have this Select either financial interest in a municipal contract. STATEMENT#1 or STATEMENT 92. _X_STATEMENT#2: 1 will have a new financial interest in a contract made by a municipal agency. My financial interest in a contract made by a municipal agency is: A compensated, non-elected position with a municipal agency. X A contract between a municipal agency and myself. Write an X _ by your financial —A financial benefit or obligation because of a contract that a municipal agency has with another interest. person or with a company or organization, _Other work because a municipal agency has a contract with my company or organization and am a"key employee"because the contract identifies me by name or it is otherwise clear that the municipal is contracting for my services in particular. BOX#2 NON-ELECTED SPECIAL MUNICIPAL EMPLOYEE I am a non-elected special municipal employee (compensated or uncompensated). Select either —STATEMENT#1: I had a financial interest in a contract made by a municipal agency,other STATEMENT#1 or than an employment contract,before I took a non-elected,compensated special municipal employee position. 1 will continue to have this financial interest in a municipal contract. STATEMENT#2. My financial interest in a contract made by a municipal agency is: A contract between a municipal agency and myself, but not an employment contract. Write an X by your financial A financial benefit or obligation because of a contract that a municipal agency has with another interest. —person or with a company or organization. OR STATEMENT#2: 1 will have a new financial interest in a contract made by a municipal agency. My financial interest in a contract made by a municipal agency is: A compensated, non-elected position with a municipal agency. A contract between a municipal agency and myself. r� _A financial benefit or obligation because of a contract that a municipal agency hath another person or with a company or organization. c_ X0 l _Other work because a municipal agency has a contract with my companylrgarifatiort' id I am a"key employee"because the contract identifies me by name or it is o-40 isefqlear fllydt the municipal is contracting for my services in particular. 0rr- FINANCIAL INTEREST IN A MUNICIPAL CONTRACT .e Name and address This is the"contracting agency." of municipal agency Town of Lexington Conservation Commission that made the contract Write an X to confirm X In my work as a special municipal employee for my Municipal Agency, I do not participate in this statement. or have official responsibility for any of the activities of the contracting agency.