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Conflict of Interest is defined as the participation in any activity, recommended actian, <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 ar equitable interest in any business which could be constn�ed as a conflict of <br />interest? Yes X No <br />If yes, provide details on a separate piece of paper, <br />ReneeMoodie �"�.��.��� ��,;�`{jZ"'.,�� <br />i <br />Applicant Signature <br />3-24-13 <br />Date <br />Questions may be directed to the City Clerl�'s office at 218-568-5222. <br />Return Completed Application to: <br />City of Pequot Lakes <br />City Clerk <br />4638 County Road ll <br />Peqnot Lakes, NIN 56472 <br />E:mail: sbeine@�equotlakes-mn.�ov <br />Website: www.peauotlakes-mn.�ov <br />l�hi.� �y�/�ii<���ii�»r �rill l>,� l,rj�t ��i� /il� h,� ,�nc �<•ur: ��lt��r �ir�i; iii��r �! u��,r �i�x��lir�i�i�,it iuu.c� �`'�� jrl<��1. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />Notes: <br />i,/� New Applicant <br />P�Tot Appointed <br />Appointed to: <br />Date Appointed: <br />Term Eacpires: <br />Applying for Reappointment <br />� <br />C:\Docmnents and Settings\nniatechalLocal Settings\Temporary Intemet Files\OLK4\Applica[ion Form for Boards and Commissions.doc <br />Page 3 <br />