In accordance with Massachusetts General Laws, Chapter 28 of the Acts of 2009, I have been furnished a copy of the Summary of Conflict of Interest Law for Municipal Employees.

~ ACKNOWLEDGMENT OF RECEIPT ~

I hereby acknowledge that by entering in the information requested below that I have read in full the summary of the conflict of interest law for municipal employees, revised November 14, 2016.

Name:*

School/Town*

School Town

Department / Office / Board / Committee*

Email:*

When submitting, this information will be forwarded to the Town of Needham's Town Clerk's Office as required by Chapter 28 of the Acts of 2009. It is recommended that you print this page for your own records. Thank you for taking the time to read this summary and submit the required information.

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