Personal information on this form is collected under the authority of section 367(1) of the Municipal Act, R.S.O. 1990, c. M.45. It will be used to provide a document or information produced by the City of Ottawa, as requested. Questions about this collection may be directed by mail to the City Clerk, City of Ottawa, 110 Laurier Avenue West, Ottawa, ON, K1P 1J1.
Administrative use only
Completed Yes No
Completed by ________________________________