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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 />�:; <br />interest? Yes No <br />� <br />� <br />If yes, provide details on a separate piece of paper. <br />:--, � , <br />r �,�;��. � � <br />; <br />Applicant Signature <br />��t- fe ��`17 <br />� <br />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: s�eine@�ec�ttotlakes-mn.�.tov <br />Website: www.pequotlakes-mn.Qov <br />Thi.s ul�j�lir�uin�: �ril1 h�- ��•�» n�r.Jilr lr�r rn��� rc��i�: �i����r th�rt rin�r u nrir upE�lircrti���i nu�s�t hc'.jiJ����. <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 />Date Appointed: <br />Term E�ires: _ <br />C:�Docaments aud Settings\nmalecha�i.ocal Settings\Temporary Intemet Files\OLK4�.4pplicazion Form for Boazds and Coaunissions.doc <br />Page 3 <br />