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Comm nts: � �� u� CQ � `'�QksP�. <br /> � e ' <br /> 1�.J� I <br /> (�` Q�� �V e /!Vl7t�—�+� � � ���/ ��/�" "-� <br /> Conflict of Interest is defined a the participanon in any achvity,recommended action, �(�( <br /> or decision from which the individua.l 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 int in any business which could be construed as a conflict of �� <br /> interest? Yes���No <br /> If yes,provide details n a separate piece of paper. <br /> � 12 0 <br /> Applicant Signa e � Date <br /> Questions may be directed to the City Adxninistration Office at 218-568-5222. <br /> Return Completed Application to: City of Pequot Lakes <br /> City Administrator <br /> 4638 Main Street <br /> Pequot Lakes,MN 56472 <br /> E-mail: nmalecha�a,pec�uotlakes-mn.gov <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 /> S:Wdminishration\City Clerk�Boazds and Commissions�Application Process and Forms�Forms�Application Form for Boarde and Commiasiona.doc <br /> Page 3 <br />