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C��ents:�- �CAuE y4L5c� pu>nF�l D4 l�t�;:-/I.�.i�:vn t� �:,q,2 <br /> ( �p�EA ,� i T/7 C�IU�Q �8!' �rKPLD4��.S <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 interes in any business which could be construed as a conflict of <br /> interest? Yes �No <br /> If yes,provide details on a separate piece of paper. <br /> �� �� . . �.�� J/�/� � <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(�a,pequotlakes-mn. o�v <br /> Website: www.pequotlakes-mn. o�v <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 /> S:�Administration\City Clerk�Boards and Comm�ssionsWpplication Proccss and Fom�s�FormsWppLcation Form for Boards and Commissions.doc <br /> Page 3 <br />