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Conflict of Interest is defined 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 ✓No <br />� <br />� <br />If yes, provide details on a separate piece of paper. <br />� ' �.. � �v - ��� - �� <br />Appli nt Signature Date <br />Questions may be directed to the City Clerk's office at 218-568-5222. <br />Return Completed Application to <br />City of Pequot Lakes <br />City Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E:mail: speine�c��pequotlakes-nm.�ov <br />Website: www.pequotlakes-mn. o�v <br />77iis ap�liccrtioi� li•ill he kept on file for o�ie ti�ecu; uftcr thcrt tinie a ne�r applicattoft f�7ust be_filed.l <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term Expires: _ <br />C:\Documents and Settings\Owner\Local Settings\Temporary Internet Files\Content.lES\S6GQ5811'�Application Fonn for Boards <br />and Commissions.doc <br />Page 3 <br />