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, <br /> Comments: ' ��. U�- 1' �J ry r,� � �� ���, ,-• �,� ���. <br /> �j 'r r f � �� 7 J / ` � A �'� � / L� 7 /' �.. <br /> ` f=' �C J , A �-` i1 {- p"L ��� O S l ' d!/'1 <br /> ��� ��- C w�fJ r���r�C �l� ��r��i�' .�� �- j,� ;� ;�y�= , . �.�.� - 9- -� !', � y <br /> Conflict of Interest is de�ned as the participation in any activity,recomm�en�drachon,� �� ' <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 equita.ble 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 /> � ' � 7��-' ,-�'�'' J�-�- 0 � <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 Main Street <br /> Pequot Lakes,MN 56472 <br /> E-mail: nmalecha(�a,pequotlakes-mn.g,ov <br /> Website: www.pequotlakes-mn.gov <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 Ezpires• <br /> Notes: <br /> C:\Users�holleys�AppData�LocalUl�icrosoft\windows\Temporary Internet Files\ContentIE5l5XAXQKX6Wpplicarian Form for Boards and <br /> Commissions.dce <br /> Page 3 <br />