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ANSWER THE QUESTION IN THIS BOX <br /> FILL IN IF THE CONTRACT IS BETWEEN THE MUNICIPAL AGENCY AND YOU. <br /> THIS BOX 4R - Please explain what the contract is for. <br /> THE NEXT BOX The contract is a license agreement permitting public access across land owned by me as <br /> part of a municipal trail system. <br /> ANSWER THE QUESTIONS IN THIS BOX <br /> IF THE CONTRACT IS BETWEEN THE MUNICIPAL AGENCY <br /> AND ANOTHER PERSON OR ENTITY <br /> - Please identify the person or entity that has the contract with the municipal agency. <br /> - What is your relationship to the person or entity? <br /> - What is the contract for? <br /> What is your - Please explain the financial interest and include the dollar amount if you know it. <br /> financial interest My financial interest is a is nominal consideration ($11year) in consideration of the license. <br /> in the municipal <br /> contract? <br /> Date when you March 26, 2019 <br /> acquired the <br /> financial interest <br /> What Is the financial - Please explain the financial interest and include the dollar amount if you know it. <br /> interest of your None <br /> immediate family? <br /> Date when your NIA <br /> immediate family <br /> acquired the <br /> financial interest <br /> Employee signature: — <br /> Date: 6 January 2022 <br /> Attach additional pages if necessary. <br /> File your completed,signed Disclosure with the city or town clerk. <br /> r-' <br /> t <br /> 07- (;-� r*" <br /> --4 — <br /> Or-0 <br /> Form revised February,2012 i <br />