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P <br /> 7 <br /> f <br /> t <br /> -ACXW0-W.CEDqNPN9-0F RECEIPT- <br /> I, the undersigned, have received a copy of the Summary of the <br /> Conflict of Interest Law for Municipal Employees (Version 5: Revised <br /> December 23, 2011). <br /> PRINT NAME: <br /> SIGNATURE: <br /> DEPARTMENT/: <br /> BOARD/COMMITTEE <br /> DATE: <br /> Please return this acknowledgment form to Kim Landry in the <br /> Human Resources department no later than January 5, 201.7. <br /> Thank you! <br /> Prepared by HR, 12/12/12 <br />