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v '+ <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 equitable interest in any business which could be construed as a conflict of <br /> interest? Yes ✓No <br /> If yes,provide deta.ils on a separate piece of paper. <br /> c�.��-- � ��- /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 Lakes, MN 56472 <br /> E-mail: nmalecha(�a,pequotlalces-mn.gov <br /> Website: www.pequotlakes-mn.�ov <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant Applying for Reappointment <br /> Conncil Action: Not Appointed <br /> Appointed to• <br /> Date Appointed• <br /> Term Eapires• • � <br /> Notes: <br /> S:1Sandy Documents\City C1erklBoards and Commissions\.Applicarion Process and FormsWpplication Form for Boazds and Commissions.doc <br /> Page 3 <br />