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Conflict of Interest is defined as the participation in any activity, recommended action, <br />NN., 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 />, I0' ` ZI -©f <br />A cant Signature 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 11 <br />Pequot Lakes, MN 56472 <br />This application will be kept on f le for one rear; after• that time a new application must be falecl. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: _ <br />Date Appointed: <br />Term Expires: _ <br />Page 3 <br />