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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 intere m 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 />� �/�� /� <br />Applicant �gnature 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 Sb472 <br />E:mail: speine���a�otlakes-mn.�ov <br />Website: �vww.neauatlakes-mn.�ov <br />OFFICE USE ONLY <br />The Applicant is: New Applicant Applying for Reappointment <br />Council Action: Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term E�ires: <br />Notes: <br />C:�Documents and Setfiugs\nmalecha\Local Settings\Temporary Io[erne[ Files\OLK4Wpplication Form for Boards and Commissions.doc <br />Page 3 <br />