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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 />If yes, provide details on a separate piece of paper. <br />�� � / <br />�' ����-�.� <br />Applica�it Signature Date <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: speine@peauotlakes-mn.gov <br />Website: www.�eauotlakes-mn^gov <br />Tlti.s �i��/�lic�uiinr� ia�ill hc� kc���t ��ii filc' /�,r nnc yc ur: uftc�r lltar tt��izz� u�tc��r cr/�pli<•utiutt r�au.��t Ix� filc c/. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />Notes: <br />New Applicant Applying for Reappointment <br />Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term Expires: <br />C:\Documents and Settings\nmalechx\Local Settings\Temporary Internet Files\OLK4\Applicntion Form for Bovds and Commissions.doc <br />Page 3 <br />