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Conflict of Interest is defined as the participation in any activity, recommended action, <br />or decision fiorn 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 X No <br />If yes, provide details on a separate piece of paper. <br />Applicant Signature Date <br />Questions may be directed to the City Clerk's office at 218 -568 -5222. <br />Return Completed Application to <br />City of Pequot Lakes <br />City Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />Email: speineC oeauotlakes- tmixov <br />Website: www.Deuuotlakes- mn.gov <br />/11r],�run79rrerl:r��yi1�'lLM r,ui � ir�r�r��re ��_ r�iFl: rvl�eaar7rwr��ari ,,�.,,.,,11r,�iY. n� era 9r'irir�11i11 <br />OFFICE USE ONLY <br />The Applicant is: New Applicant Applying for Reappointment <br />Couneil Action: �`— Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term Expires; <br />Notes: <br />CADocumenis and Settings \nmalechatLocal SettingMemporwyIni met Fhs1OLKAApplica ion Form for Boards and Commissions,doc <br />Page 3 <br />