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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 />fi <br />Applica 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 />E:mail: sueine rr,ueQuotlakes- nnri.aov <br />Website: www.vequotlakes- nrn.gov <br />1111rya.�rrrr,J�lru�i�y�........ ... 79V' ��u' is��., �. Yuririrr��e�' rru: urr�l '��'l�eril�lr����rra��t�s.� awl <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 Documents\City ClerklBoards and Commissions\Application Process and ForniMppiication Form for Boards and Commissions.doc <br />Page 3 <br />