Peter George 20(b) disclosure — File 26-0731

Name of municipal emp loyee: Title/ Pos ition Fill in this box if it applies to you. Agency/ Department Ag ency Address Office phone: Office e-mail : Starting date as a municipal employee. BOX# 1 Select either STATEMENT #1 or STATEMENT #2. Write an X beside your financial interest. BOX #2 Select either STATEMENT #1 or STATEMENT #2. DISCLOSURE BY MUNICIPAL EMPLOYEE OF FINANCIAL INTEREST IN A MUNICIPAL CONTRACT AS REQUIRED BY G. L. c. 268A, § 20(b) MUNICJPAL EMPLOY_EE_INFORMATION - - fe-ler &leorcf... e__ - eQGff(:0,-t\D~~~ 1 fl:t ra,/J1lJf~~510/l~ I J A; l-e- ( _Jf you are a municipal employee because am unicipal agency has contracted with your company or o.rganiz~tion, please provid~ the name~ nd address of the company or organization . - . 5o Mefv) \ l-e. ub \ i c. ~al S 5 c2herrv sf · StJmerJ/1· e NA ~ John 'dPn, en{)<: c/ se1 hcJc I , .5· c.he rrv 01 - ~Jl/erv1/le /1A- t11) &Jr>< s - lo~ {:"'IQ - / Check one: Elected or v7 Non-elected -- ELECTED MUNICIPAL EMPLOYEE I am an elected municipal employee. _ STATEMENT #1 : I had one of the following financia l interests in a contract made by a m·unicipal agency before I was elected to my municipal employee position . I wi ll continue to ~ ave this financial interest in a municipal contract. OR TATEMENT #2: I wi ll have a new financial interest in a contract made bya municipa l agency. Z f ancial interest in a municipal contract is: have a non-elected , compensated municipal employee position . __ A municipal agency has a contract with me. __ I have a financia l benefit or obligation because of a contract that a municipal agency has with another person or an entity, such as a compa ny or organization . __ I work for a company or organization that has a contract with a municipal agency, and I am a "key employee" because the contract identifies me byname or it is otherwise clear that the city or town has contracted for my se1·vices in particular. NON-ELECTED, COMPENSATED MUNICIPAL EMPLOYEE ~ on-elected municipal employee. ATEMENT # 1: I had one of the following financial interests in a contract made by a municipal agency before I took a position as a non-elected municipal emp loyee. lwill continue to have this financial interest in a municipal contract.

Write an X beside your financial interest. Name and address of municipal agency that mad e the contract Please put in an X to confirm these facts. FILL IN THIS BOX OR THE BOX BELOW FILL IN THIS BOX OR THE BOX ABOVE My financial interest in a municipal contract is : ;:-;/ municipal agency has a contract with me, but not an employment contract. ~ n,have a fin ancia l benefit or obligation because of a contract that a municipal agency has with anoth er person or an entity, such as a company or organization. •• OR •• ~ TATEMENT # 2: I will have a new financia l interest in a contract made by a municipa l agency. My/inancial interest in a municipal contract is: _ _ I have a non-elected, compensated municipal em ployee position. __ A muni cipal agency has a contract with m e. __ I have a financia l benefit or obligation because of a contract that a municipal agency has with another person or an entity, such as a company or organization. __ I work for a company or organization that has a contract with a municipal agency, and I am a "key employee" because th e contract identifies me by name or it is otherwise clear th at th e city or town has contracted fo r my services in parti cular. FINANCIAL INTEREST IN A MUNICIPAL CONTRACT Soy"I\Q){\I\ \\t( '?o/ ~ <::, ~~ ~~ l"CA ~ lY) t;e ~ -~ \(pl ~\\~¥\~ ~:V«A ~J\A_ ¼~ St/\l'v\R_'l'\f\~Z ~R - o7-. \ L-\ Ci "My Municipal Agency" is the municipal agency that I serve as a municipal employee. The "contracting agency" is th e municipal agency that made the contract. 0y Municipal Age ncy is not the contracting agency. VMY Muni ci pal Agency does not regulate the activities of th e contractin g agency. _Vin my work for my Mu nicipa l Agency, I do not participate in or have officia l responsibility for any of the activities of the contractin g agency. ~e contract was made after public notice or through competitive bidding. ANSWER THE QUESTION IN THIS BOX IF THE CONTRACT IS BETWEEN THE CITY OR TOWN AND YOU . -;;eJ:::\ whf;;r~:~ hs ~ ~~ ~- ~~'<~ ~~ \ l~ ctt- 1/\. V'c\:i~ ~ ~ 6'i fR Sr~ 0 o h( . :bk ~t::: OV\J.- &, w'fw-'$ '\") oil J, Mt- 01/ll \q,? e,.i \--1\t jl:)St \ii'\ 0,\ • --\\ii ,;l.\(5' \ \ ANSWER THE QUESTIONS IN TH IS BOX 1\,-fw· 1 IF THE CONTRACT IS BETWEEN THE CITY OR TOWN AND ANOTHER PERSON OR ENTITY. - Please identify the person or entity that has th e contract with the municipal agency. - What is your relation ship to the person or entity? - Wh at is th e contract for?

What is your financial interest In the municipal contract? Date when you acquired a financial interest What is the financial interest of your immediate family? Date when your immediate fam ily acquired a f inancial interest Write an X to confirm each statement. Emp loyee signature: Date: - Please explain the financial interest and include the dollar amount if you know it. - Please explain the financial interest and include the dollar amount if you know it. FOR A CONTRACT FOR PERSONAL SERVICES - Answer the questions in this box ONLY if you will have a contract for personal services with a municipal agency (i.e., you will do work directly for the contracting agency). I will have a contract with a municipal agency to provide personal services. /2e services wi ll be provided outside my normal working hours as a municipal employee. ~ e services are not required as part of my regular duties as a municipal employee. ~ these services, I wi ll be com pensated for not more than 500 hours during a calendar year. Attach additional pages if necessary. NOT A PERSONAL SERVICES CONTRACT -- File disclosure with the city or town clerk. SEE CERTIFICATION AND APPROVAL REQUIRED FOR PERSONAL SERVICES CONTRACTS, BELOW.

I.' ! I , ,, j FOR CONTRACTS FOR PERSONAL SERVICES ONLY: If you are disclosing a financial interest in a contract for personal services with a municipal agency, you must file the Certification below signed by the head of the contracting agency, and you must get approval of the exemption from the city council, board of aldermen, board of selectmen or. town· council. Name: litle/ Position Municipal Agency: Ag ency Address: Office Phone: KJ.. Lignature: Date: Name: litle/ Position Ag ency Address: Office Phone: Signature: Date: CERTIFICATION BY HEAD OF CONTRACTING AGENCY INFORMATION ABOUT HEAD OF CONTRACTING AGENCY ;O~N\\\L -Pl1'VI<:$ CW\rl to,Q, fCA ,,lfV\ t~1 Hol~\/\ cl :,11t,c-.\-· . ~ :}__o·r; l)(~(-hv-a, 'X" ~ roI44 'H-e I IW'\ ~ \7 ·- ~)_t; --{p(pob ·- X Rllo CERTIFICATION I have received a disclosure under G.L. c. 268A, § 20(b) from a municipal employee who seeks to provide personal services to my municipal agency, identified above. I certify that no employee of my agency is available to perform the services described above as part of his or her regular duties . ... ,., >f /~--::::-:.:.::,,-~--------7 _,.,/ 2 r; APPROVAL BY CITY COUNCIL, BOARD OF ALDERMEN, BOARD OF SELECTMEN OR TOWN COUNCIL INFORMATION ABOUT APPROVING BODY APPROVAL I have received a disclosure under G.L. c. 268A, § 20(b) from a municipal employee who seeks to provide personal services to a municipal agency, identified above. The exemption under§ 20(b) is approved. On behalf of the Council or Board, I sign this approval. Attach additional pages if necessary. File disclosure, Certification and Approval with the city or town clerk. Form revised February, 2012