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1' <br /> COI111I18IItS' <br /> Conflict of Interest is defined as the participation in any activity,recommended action, I <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 wluch could be construed as a conflict of <br /> interest? Yes �No <br /> If yes,provide details on a separate piece of paper. <br /> � � <br /> « ���� <br /> Applicant Signature Date <br /> Questions may be directed to the City Administration Offce at 218-568-5222. <br /> Return Completed Application to: City of Pequot Lakes i <br /> City Administrator ', <br /> 4638 Main Street ', <br /> Pequot Lakes,MN 56472 , <br /> E-mail:nmalecha a�gnotlakes-mn.g,ov <br /> Website: www pequotlakes-mn.�ov � <br /> ' <br /> , � <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant Applying for Reappointment <br /> Council Acflon: Not Appointed <br /> Appointed to• <br /> Date Appointed: <br /> Term Ezpires• <br /> S:Wdministntion\City ClerkrBoards and Commisaions�AppHcation Process and Forms�FormsWpplication Form for Boazds and Commisaions.doc <br /> Page 3 <br />