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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 ir� any business which could be construed as a conflict of <br />interest? Yes d�� No <br />If yes, provide details on a separate piece of paper. <br />���� �� � <br />i � , .� � �;� � �� <br />�� �=�i. � �. �, ,� � �, <br />�� <br />Appl.i.�ant 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: speineCC�pequotlakes-mn.�ov <br />Website: www.�equotlakes-mn �ov <br />Tlti.s up��lic�ui��ri w•r/l hc� kept nia.%il�� %nr urrc r�ec�r: utt�r �hu/ �h�ue� c� ��e�r upplr�•ci�rnf� rratt.s� he' f i/ed. <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\nmalecha\Local Se[tings\Temporary Inter�e[ Files\OLK4\Application Form for Boards and Commissions.doc <br />Page 3 <br />