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Attendance:Are you aware of the importance of regular meeting attendance including <br /> the time commitment involved in preparing for meetings and do you feel you have the <br /> time available to be an active participant? A- Yes No <br /> Commen Y '� <br /> Lt. —(4.1ct-m4 —Ake('- <br /> 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 inter in any business which could be construed as a conflict of <br /> interest? Yes .No <br /> If ye, provide details o. a separate piece of paper. <br /> r)-1 zI <br /> .plicant Si ; +7 Date <br /> Questions may be directed to the City Administration Office at 218-568-5222. <br /> Return Completed Application to: City of Pequot Lakes <br /> City Administrator <br /> 4638 Main Street <br /> Pequot Lakes,MN 56472 <br /> E-mail:cityhall@pequotlakes-mn.gov <br /> Website:www pequotlakes-mn.gov <br /> /his ul-?hlic'crliorr frill LU G��l?I 01?(I/o/H1 alnv linty a tn'i1 )11(..alto')nucsl he/1/el <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant ZApplying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to: L�C <br /> Date Appointed: / —41—Z/ <br /> Term Expires: /2—.3 I— <br /> SAAdnfirdstmiion1City Claric'Boards and Commission Application Process and Forms\Forma\Applicadon Form for Boards and Commintons.doo <br /> Page 3 <br />