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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 />Appliead §fgnature 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 l I <br />Pequot Lakes, MN 56472 <br />E :mail: sueine @oeauotlakes- mn.jov <br />Website: www.Detauotlakes- mn.aov <br />F 01 1t1gAr ,FL��t'ilz'riiil]i1.r�ha:u�r rafil r ,ri.ri�r�4�'rtar %aai }urrily,',, M tStLrt LliKUil�rarrrtacf'�I�rre�Lt��ltl <br />OITICE 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 />C ;Mocuwnts and Settingslnmalecha\Local Seldngffemporary Hemet HeAOLM\Application Form for Boards and Commissions.doe <br />Page 3 <br />