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`.- Conflict of Interest is detined �is the participation in 2111y activity, 1'eC0I11I11�I1CIt;CI action, <br />or decision trom which the individual has or could havc the potential to receive personal <br />�ain, whcther ic is direct or inclirect. In accordance ��ith this del'inition, do you have any <br />le�al nr ec�uitable interest in any business which could be construecl as a conilict oi' <br />interest? Yes � No <br />� <br />� <br />If'yes, pravide detaits on a s�p�iratc piece o('paPer. <br />�'� • ,�.. �����t�./ <br />,/� /.sf��/�1 lL.�.i <br />A �icant Sianitarei D�itc <br />PP � <br />Questions rz�ay be directeci to the Ciry Clcrh's ol'fice at 2! f�-5G8-5222. <br />Return Co»�pletec! Application to <br />City oF Pec�u�t Lakcs <br />City C1Grk <br />4G38 County Road I 1 <br />Pequot L�kes, MN 56472 <br />E:maiL• ��ciit �cCct; ��uc�tl�ikes-mn._.ct�. <br />�'VcLsitc: ��t�������-l��iltic>Ilul:c�-i»n__�c��, <br />//brltitr���iu11���riluu��yilYli:�'��n �i�riAl:l►t�iii�i�'�f:7��1*4rrj��41`trrid�in=�'e��n�liYri�ri���$t�+lih�rlui�r�'S.:�Yjjj'l�lli <br />oFricr usr oNi,v <br />7'hc Applicant is: <br />Couneil Action: <br />Notcs: <br />�,�.�... ,.�, , ......�_�.... � �� � � . ..... ,. � � , <br />_ New A}�plicant _Appl��ing i'or Rc��ppointmc�it <br />Not elnpointed <br />Appointed to: <br />Dalc Appointed: <br />'Ccrm I:xpires: __ <br />;� ..� � ,,.. . � ��. „�.,�: ; �:, . . . . �.,�.�,...;: , . � � . � . , , <br />C\Di>cumcros .md Scttings\nm;dcch;i�l Ak:d Sc�iim,slTant�x�r:�ry tntcmri (�ileslOt.K•iirtppli.:nion Purm for Bo;vd.:u�ci Cornmisaioocduc <br />P�lge 3 <br />