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Comments: <br /> Conflict of Interest is defined as the participation in any activity,recommended action, <br /> or decision frorn 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 /> �� �� " ��' <br /> p icant ignatur 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: nmalechana,�equotlakes-mn. o�v <br /> Website: www.�equotlakes-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 Eapires• • <br /> Notes: <br /> S:�AdministrationlCity ClerklBoards and CommissionsWpplication Process and Forms�FormslApplication Form for Boards and Commissions.doc <br /> Page 3 <br />