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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 />� <br />L <br />If yes, provide details on a separate piece of paper. <br />� <br />� �. <br />Appli� ature <br />�� <br />Date <br />� - � 3 -- l `�- <br />Questions may be directed to the City Clerk's office at 218-568-5222. <br />Return Completed Application to: <br />City of Pequot Lakes <br />City Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E:mail: sneine(a�peauotlakes-mn.�ov <br />Website: www.ueauotlakes-mn.�ov <br />i//°6��7�ya����i�7dy�a��lirr�.y�17�i�a'���ir�ir�� 7atiwi�v�,_ ,,a���il .u'i�i��11u� e�ia .����i��.�7dye����1er��rr��A��y��i�a�flYa:li <br />OFFICE USE ONLY <br />The Applicant is: <br />Councit Action: <br />Notes: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term Expires: <br />S:\Sandy Documents\City C1erk�Boazds and Commissions�P.pplication Process and Forms�Application Form for Boards and Commissions.doc <br />. Page 3 <br />