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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? N/ Yes No <br /> Comments: Ars j„v,c; ca civ`&. r —\.4 t°t-j,+.M\ ca ;^.C—t fftk <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 /> Applicant Signature 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 /> 7hi.4(Ip/>G,ca on u'l//ht'kt'//i nn ftlt'%nr nnt'!car: alirr/har!iuu°a nc>> a//////((/f/un/11!1(1 be ft/Ct/. <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant 4pplying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to: Po+ z Co 1,1714 35 toy. <br /> Date Appointed: /— &ZO <br /> Term Expires: /— to z-ci <br /> SAMminfrarationTity Clank\Boa ds and Commissions Application Process and FomreWorms\Application Form for Boards and Commiseions.doo <br /> Page 3 <br />