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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 _X_No <br />If yes, provide details on a separate piece of paper. <br />Applicant Signature Dat4 <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: sneine ameciuotlakes- mn.Rov_ <br />Website: wwwxeauotlakes -nmaov <br />f1'irl�err�u'194eii1��r�ullk' a r.Yprr n�e�rarr/I��i' fur► 9��itrri���e����iil�e »is���r�.�� tip:1��11 <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 />Notes: <br />SASandy DocnmentslGty C1e&Boards and Commissions\Application Process and FormslApphcation Form for Boards and Commissions.doc <br />Page 3 <br />