Letter-Disclosure of Interest

Board of Fire Commissioners

___________ Fire District

123 Anywhere Street

Someplace, New York 12345

Re: Conflict of Interest

Pursuant to General Municipal Law §800 and the Code of Ethics of the _______________ Fire District, I disclose the following:

(Set forth here the nature and extent of such interest.)

Copies of this disclosure are being furnished to the Secretary of the ___________ Fire District to become part of the official minutes of the Board of Fire...