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C�nflict af Interv�t is defi�:e�i a$ t�'i�, pc"A�'iiCi'�'d�i`�ii iP. `daij' �ii.iS`Ji�y� i�a^,vi1'u'Tl�ilua°.Q� u�iiQi3� <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 />�_��r�1� ��� �t.,�7'' c�'�� �3 % a� / � �1 d � <br />Applicant Signature Date <br />�u°va�1�3i1S 121?a� fJG uii°v�.ie.0 �� �ii°v �it�'i..i%ii��a ^vi�1CP. c"it 2.iaQi-S�O`5222. <br />Return Completed Application to: <br />City of Pequot Lakes <br />�ity �Cl�rk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E:mail: s;��z����?��q�otlai�es-rnal.��v <br />Website: `�w�. e��uotlakes-mn.�ov <br />�J7(� (rl�l�ill'u�lr�lf 11'lii� (h� i�c'Pi ��71:[/t' `��l-��Ilt� `.-tc(?:' .11!e-r-:ii�i,- iR/!c' �� �ic't�,� ilir�P!l��.:Ilt�li �1111�1 ht� ilfi���. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />Notes: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: _ <br />Date Appointed: <br />Term Expires: _ <br />C:�Documents and Settings�nmalecha�I,ocal Settings\Temporary Interne[ FIles\OLK4\Application Form foc Boards and Commissions.doc <br />T_�_ 7 <br />