Municipal Conflict of Interest - Complaint Form 2

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Municipal Conflict of Interest Act - Complaint Form #2

STATUTORY DECLARATION

PLEASE NOTE: This form is fillable but you will have to come into the office to sign in front of a Commissioner of Oaths.

of the Township of West Lincoln in the Province of Ontario.

I SOLEMNLY DECLARE THAT:

1. I reside at:

My telephone number is:

My email address is:

2. I have reasonable and probable grounds to believe that: (specify name of member)

a member of the Council of the Corporation of the Township of West Lincoln or a local board of the Township, has contravened section(s) of the Municipal Conflict of Interest Act, R.S.O. 1990, c. M.50.

Specify Section(s):

The particulars of which are attached hereto (attach any additional documentation)

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3. I became aware of the facts constituting the alleged contravention not more than six (6) weeks ago and they comprise the following:

This declarartion is made for the purpose of requesting that this matter be investigated by the Township of West Lincoln's integrity Commissioner and for no impropert purpose.

DECLARED before me at the

Dated

Signature (to be signed in front of a Commissioner)

A Commissioner for taking affidavits etc.

Please note that signing a false affidavit may expose you to prosecution under ss. 131 and 132 or 134 of the Criminal Code, R.S.C. 1985, c. C-46 and also to civil liability for defamation.

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Municipal Conflict of Interest Act - Complaint Form #2

STATUTORY DECLARATION