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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 e construed as a co ct of <br /> interest? X Yes No /45 Pas.e. , - •* -4n63 els r /s' yr, <br /> /F• 1,151,1 51Afr 1 ReSM if /I t,e. ' 55=-4 <br /> If yes,provide details on a separate piece of paper. Sez 44 Ase'oss( / 7 7 ‘. <br /> I • a A 4,9-- <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@a,pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.gov <br /> This application will be kept on file for-one year: after that time a new application must he filed. <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant 'Applying for Reappointment <br /> Council Action: Not Appointed <br /> • <br /> Appointed to: <br /> Date Appointed: <br /> Term Expires: <br /> Notes: <br /> S:\Sandy Documents\City Clerk\Boards and Commissions\Application Process and Forms\Application Form for Boards and Commissions.doc <br /> Page 3 <br />