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Comments: �6�►�-�� �\ \� �� 0. � (� �'�� �`��S�q t�4�i <br /> o�,J . c� -Q u�� <br /> � �� cn�o�� � <br /> � b� ��c ; c ; �L. -�o�2 �.� c�v�.�� rr� Y��L i � b� � S <br /> Conflict of Interest is defined as the participation m any activity,reco ended acti n, <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 /> If yes,provide details on a separate piece of paper. <br /> !a- / � ao <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.� <br /> Website: wwwpequotlakes-mn.gov <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:�Administratwn\City Clerk�Boards and Commiss'ansWpplication Proccss and Forms�Forms�Apphcation Form for Boards and Commissions.doc <br /> Page 3 <br />