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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 __)�_No <br />If yes, provide details on a separate piece of paper <br />/9-a-7�a; <br />Applicant SignatLke Date <br />Questions may be directed to the City Clerk's office at 218-568-5222. <br />Return Completed Application to <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />Notes: <br />City of Pequot Lakes <br />City Administrator/Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E-mail: <br />Website: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: -- <br />Date Appointed: <br />Term Expires: <br />S:\AdminL4rationlCityekerkl13oards and CommissionslApphcattonProcess and Forms\Forms\Application Foam for Boards and C.Dn m 10W.doc <br />Page 3 <br />