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Comments: <br /> Conflict of Interest is defined as the participation in any activity,recommended action, <br /> or decision from which the individua.l 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 /> �v� �� �,�,�.�- a��2Z- �7 <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 Administrator/Clerk <br /> 4638 County Road 11 <br /> Pequot Lalces,MN 56472 <br /> E-mail:nmalechana,pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.� <br /> OFFICE USE ONLY <br /> The Applicant is: New AppGcant Applying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to• <br /> Date Appointed• <br /> Term Ezpires• <br /> Notes: <br /> S:4ldminisaation\City C1crk�Boazds and ComwssionsWpplication Process and Foims�Forms�P.pplicaLon Form for Boazds and Commissions.doc <br /> Pa.ge 3 <br />