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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 /> If yes,provide details on a separate piece of paper. <br /> 6?;ket_,I.-(6t Of � 4/k <br /> Applicant Signatur 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 Administrator/Clerk <br /> 4638 County Road 11 <br /> Pequot Lakes,MN 56472 <br /> E-mail: nmalecha@pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.gov <br /> i!r(?i1 II in h.' Li)/(i1 iiic 71!i (1iA' l c'U!'; (!/ic'i'i/ni! ii111n U iinn viinc!!io17 i]]li. l/)c• <br /> OFFICE USE ONLY <br /> The Applicant is: ✓ New Applicant Applying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to: <br /> Date Appointed: <br /> Term Expires: <br /> Notes: <br /> C:\Documents and Settings\Mark\Local Settings\Temporary Internet Files\Content.IE5\6OV VUNVVN\Application Form for Boards and <br /> Commissions.doc <br /> Page 3 <br />