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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 /> Comments: <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 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 /> *11",, 1-271G/2..t <br /> •• (1111 a Date <br /> Questions ay 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 /> This application will be kept°Ole le for one year: a/ier that time a new application must be filed <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant Applying for Reappointment <br /> Council Action: Not Appointed <br /> X Appointed to: pig'lc-P--- 80-Y4YeA <br /> Date Appointed: 1 — —2.13a2, <br /> Term Expires: 12.-31- 2-®7,-1 <br /> S:\Administration\City Clerk\Boards and Commissions\Application Process and Forms\Forms\Application Form for Boards and Commissions.doc <br /> Page 3 <br />