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Conflict of Interest is defined as the participation in any activity, reconnmended 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 />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, N N 56472 <br />E:mail: speine nequotlakes- mn.Rov <br />Website: www.pequotlakes- mn.aov <br />ii6rhYtrt. t. 9lktril. vaiAl' k: 4s straayr iI} Matt, tl lr�rlhrr� I'll �7leat lti "tairr���yY t�dilasl� <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 />S:1Sandy DacumentslCity ClerkToards and ComnissionslA,pplication Process and FonnAApplicaion Form for Boards and Commissions.doc <br />Page 3 <br />