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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 interesr/'ln 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 /> �� 1�Z , I�b �� �l <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,NIN 56472 <br /> E-mail: nmalecha(a�ueauotlakes-mn.gov <br /> Website: www.pequotlakes-mn.�ov <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 E�ires: <br /> S:�Administration\City Clcrk�Boards and CommissionsV�pplication Process and Forms�Fom�sUpplication Fortn for Boards and Cocnmissions.doc <br /> Page 3 <br />