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' i <br /> Comments: ' <br /> �I <br /> i <br /> 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 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 /> G, ,� <br /> � ��....- l'���,.,�� .�� /�/� <br /> Applicant Signa e 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.(c�pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.�ov_ <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 Eapires: <br /> Notes: <br /> S.Wdminishaiion\City Clerk�Boards and CommissionsWpplicatton Process and Forms�F'ormsWpplication Form for Boards and Commissions.doc <br /> Page 3 <br />