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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? X 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 x No <br /> If yes,provide details on a separate piece of paper. <br /> 1 <br /> 12/17/2021 <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:cityhalla,pequotlakes-mn.gov <br /> Website:www.pequotlakes-mn.gov <br /> This application will be Reil onhle%or one)-ear;a/ler Ilan tinge a new applicni,oa 7,nrSI he lined. <br /> OFFICE USE ONLY <br /> The Applicant is: _ New Applicant Applying for Reappointment <br /> Council Action: Not Appointed <br /> X- Appointed to: P Z Co mit-M.551oh <br /> Date Appointed: Lo 2;1— <br /> Term <br /> ;ZTerm Expires: f 2— !- 2o2-Li <br /> thlAdmhderationkCityClerkiBoards and CommisskaMpplicatton Prods and Nassau=\!OgFarm for Boards and Cammissiaas doo <br /> Page 3 <br />