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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 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 /> 8 / 10i 1 14 <br /> Applicant Signature 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 @pcquotlakcs-mn.gov <br /> Website: www.pequotlakes-mn.gov <br /> Thi. application I'll/he kept on lilt fr)r one rear: c/ficr that time tr Heir application t/taw he filed. <br /> OFFICE USE ONLY <br /> The Applicant is: ✓ New Applicant Applying for Reappointment <br /> Council Action: t..7. <br /> Not Appointed <br /> Appointed to: <br /> Date Appointed: <br /> Term Expires: <br /> Notes 4 //ent "gym cor n . Psi �4rIy - <br /> Kea pplyec.I \ e"), ?©,c- <br /> S:\Sandy Documents\City Clerk\Boards and Commissions\Application Process and Forms\Application Form for Boards and Commissions.doc <br /> Page 3 <br />