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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 i_. y 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 - l - � <br />Applicant Signat e 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@pequotlakes-mn.aov <br />Website: www.pec�uotlakes-mn.gov <br />This uf�pli���ri��n tirrll hc k�•pr un_tilc .��%rc�nr� �r��ir: �ift�rth�u rin��� ci �rc�trc�f�pli<<tticui uur�tl�r� t�(ecl. <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 Eacpires: _ <br />C:\Documents and Setfings\nmalecha\Local Settings\Temporary Incemet Files\OLK4\Application Form for B oazds and Commissions.doc <br />Page 3 <br />