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Contlict 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 />Applicant � ignature 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: s�eine@pequotlakes-mn.�ov <br />Website: www.pequotlakes-mn.�ov <br />Tdti.s u��plrcatior� will he /<e��l e�n./rlr %��r nnt� ��eur: e��te��• �/��rt iiirtr c� i�rtir ���j���liccuior� metst he %ilc d. <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 />7['erm �xpires: _ <br />C:\Documents ar�d Se[tings\nmalecha\Local Set[ings\Temporary [ntemet Files\OLK4\Application Eorm for Boards and Commissions.doc <br />Page 3 <br />