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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 an business which could be construed as a conflict of <br />interest? Yes �� <br />� <br />� <br />If yes, provide details on a separate piece of paper. <br />�l'�-� �` C �'�'��, CP D <br />_�s� <br />Applicant Signature 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(a�pequotlakes-mn.gov <br />Website: www.pec�uotlakes-mn.gov <br />This application will be kept on file for one year; after that time a new application must be filed. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />Notes: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: <br />�ate �ppointe�: <br />Term Expires: _ <br />S:\Sandy Documents\City C1erk�Boards and Commissions�Applicarion Process and Forms�ApplicaUon Form for Boazds and Commissions.doc <br />Page 3 <br />