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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 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, 1 i� /1 afi)l <br />6$plicant Signature Date <br />Questions may be directed to the City Clerk's office at 218 -568 -5222. <br />Return Completed Application to: City of Pequot Lakes <br />City Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E:mail: speineQ- oeQuotlakes- nin,P-ov <br />Website: www.i)eciuotlakes- mn.gov <br />OEF"ICE 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 />Notes: <br />i <br />SASandy DocumentslCity ClerklBoards and CommissionMpplication Process and Forms4Application Form for Boards and Commissions.doe <br />Page 3 <br />