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Con�lict of Interest is deimed as the participation in any activity, recommended action, <br />� or decision from which the individual has or could have the potential to receive personal <br />gain, whether it is direct or indirect. In accordance with this definition, do you have any <br />legal or equitable interest in any business which could be construed as a conflict of <br />interest? Yes C No <br />� <br />If yes, provide details on a separate piece of paper. <br />,- ���/} � ��i� <br />r° JI�.-�- '� � <br />Ap icant Signat e Date <br />Questions may be directed to the City Clerk's office at 218-568-5222. <br />Return Completed Application to: City of Pequot Lakes <br />City Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E:mail: speine@�equotlakes-inn.a.,ov <br />Website: www.�eQuotlakes-mn.Qov <br />Tlti.s cr����lirulir,�� n•i!/ hr ��y�t urt.t71�• fr>r ��nr �•c�cn: �iltrr �hui timr �� itcir a/�/�(ir��tinn ni��.�� hc' fi/c�cl. <br />OFFICE USE ONLY <br />The Applicant is: New Applicant Applying for Reappointment <br />Council Action: Not Appointed <br />Appointed to: _ <br />Date Appointed: <br />Term E�ires: _ <br />Notes: <br />C;�Documents and Se[tings\nmalecha\Local Setrings\Temporary Intemet Files\OLK4Vlpplication Fotm for Boazds and Commissions.doc <br />Page 3 <br />