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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 />z <br />,�`�'` � �� f�'t".it'�,�._ <br />��� .� <br />Appl�;cant Signature <br />�f �? j"/a-�t�j� <br />Date I ! <br />Questions may be directed to the City Cierk's office ai 2i8-�68-5222. <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: �eine�a�quotlakes-mn.gov <br />Website: www.pequotlakes-mn.�ov. <br />This application will be kept on file for one year; after that time a new application nzust be frled. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />Notes: <br />�- <br />New Applicant v` ��hlpplying for Reappointment <br />Not Appointed <br />Appointed to: <br />Date Appoir.��d: <br />Term Egpires: _ <br />S:\Sandy Documents\City C1erk�Boazds and Commissions�Application Process and FormsWpplication Form for Boards and Commissions.doc <br />Page 3 <br />