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. <br /> d <br /> Comments: <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 wluch could be construed as a conflict of <br /> interest7 Yes �No <br /> If yes,provide details on a separate piece of paper. <br /> r <br /> ti <br /> Applicant Signature Date <br /> Questions may be directed to the City Administration Office at 218-568-5222. <br /> Return Completed Applica.tion to: City of Pequot Lakes <br /> City Administrator <br /> 4638 Main Street <br /> Pequot Lakes,MN 56472 <br /> E-mail: nmalecha a(�n, equotlakes-mn.�ov_ <br /> Website:www.pequotlakes-mn gov <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 Ezpires: . <br /> S:Wdministration\City Clerk�Boards and CommissionsWppGcation Pracess and Forma�Forms�Application Form for Boarda and Commiasiom.doc <br /> Page 3 <br />