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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 int rest 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 /> & n V4 I3OIati \ <br /> Applicant Signa ; Date <br /> Questions may be directed to the City Clerk's office at 218-568-5222. <br /> Return Completed Application to: City of Pequot Lakes <br /> City Clerk <br /> 4638 County Road 11 <br /> Pequot Lakes,MN 56472 <br /> E:mail: speine@pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.gov <br /> This application will he kept nit file et for ant vear:titter that time a new application teait!he tiled. <br /> • <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant Applying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to: <br /> Date Appointed: <br /> Term Expires: <br /> Notes: <br /> S:\Sandy Documents\City Clerk\Boards and Commissions\Application Process and Forms\Application Form for Boards and Commissions.doc <br /> Page 3 <br />