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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 mteresj 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 />1 /W13 <br />Applicant gnature 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.pec uotlakes- mn.gov <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 />C:UxU *l andSeWng&wWhaV"al geW.gsWempawy Inlem IMAOLK"ppncaltan rwofw Dowd; and Cow !%!on dae <br />Page 3 <br />