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COIIlTriCI1tS: O�t �C_ � ,ry� �'s g�`��y ���r+� <br /> b�� � , � a' � � <br /> ` �o��� � .'M P" �/'�'fr�e�e'N � <br /> Conflict of Interest is defined as the participation in any activity,recommended action, <br /> or decision&om 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 conshved as a conflict of <br /> interest? Yes � _No <br /> If yes,provide details on a separate piece of paper. <br /> �� <br /> ,�y f i�^ �� ���� � <br /> �"P� . �p <br /> App�cant Sigaat� Date � <br /> Questions may be directeri to the City Administration Office at 218-568-5222. <br /> Return Completerl Application to: City of Pequot Lakes <br /> City Administrator <br /> 4638 Main Street <br /> Pequot Lakes, MN 56472 <br /> E-mail: nmalecha�a�equotlakes-mn.� <br /> Website: www, uotlakes-mn. ov <br /> � . „ , � <br /> OFFICE USE ONLY <br /> The Apple�ant i�: 1�Tevs Applicant Applyitng for Reappointment � <br /> Council Actlon: Not Appointed I <br /> Appointed to: <br /> Date Appointed• <br /> Term Ezpires• • <br /> I <br /> S:Wdmmistration\City C1edc�Boards and Commissfong�Application Process and Forms�Fmms�Application Foim far Bouds and Commiysiom,do� <br /> Page 3 <br />