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Conflict of Interest is defined as the participation in any activity, reconmiended 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 />V z- – l – i -z— <br />Applicant Si nature 1 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: SI)Citle@ile(,ILIOIItkes-iiiii.gov <br />Website: wwky.pegninlekes- nln.gov <br />IllA�yn�n��llnuA�l t�ili�u.4yuY �laYil�Pna��lui aui�rN'laril�uY ]ri+� ir��WUm���11����Yw�n�uutr�iui 'i'hr'li <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 />Terni Exj)ires: <br />Notes; <br />it <br />CADocuments and Seuingpinmalecha\Local SettinpUcniporary Mime I Filed( Mpplicalion Fnm for Bom&d and Cmmnii+sinns.doc <br />Page 3 <br />