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Commen : Q. �, <br /> ' � � `l�i <br /> � � v w <br /> Confl�t Intere�t is d fi ed 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 /> { <br /> If yes,provide details on a separate piece of paper. <br /> � �z.���'�✓ t �-c� <br /> Applicant Signature Date <br /> Questions may be directed to the City Administration 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(�pequotlakes-mn.� <br /> Website: www.pequotlakes-mn.gov <br /> � <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 Expires• <br /> � <br /> S:WdministraHon\City Clerk�Boards and Commissions\Applica[ion Proccss and Forms\Form�Wpplicanon Form for Bauds and Comm�ssions.doc <br /> Page 3 i <br /> � <br /> � <br />