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� <br /> Comments: A�^ �Jr`dh��L /�'D1I/l�lF� �'0 7 �' �11/� <br /> L� 1.�prr��a?�' a b C�v NU�� �J�SS' o tYE' ��i�y <br /> An1�.'�"�R. �'N�tT M�1TfEl2. T�t� C�`� /1�' ���ld�?' �� <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 /> �� �l�- �30-- �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 Main Street <br /> Pequot Lakes, MN 56472 <br /> E-mail:nmalecha(�a,pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.g.,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:�Aclminislration\City C1erk�Boards and Commissions�Application Process and Forms\FormsWpplication Form for Boards and Commissions.doc <br /> Page 3 <br />