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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 ��"o' <br />If yes, provide details on a separate piece of paper. <br />r <br />.� <br />� <br />��.�� � � ��'�- i .�' °� � � �� � �/ � <br />Applicant 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: s�eineC��eqi�otlakes-mn.gov <br />Website: www.pequotlakes-mn.�ov <br />T/ti.s up/�/iccttiot� �rill he ke/�r orr frfe f'or o�1e ��c�ar; cef'te r tf2ut tim�c u riew• ap��licatinn rrutst {�c� 1i/ecl. <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 �xpires: _ <br />C:�Documents and Settings\nmafecha\Local Settings\Temporary Intemet Files\OLK4\Application Fomi for Boazds and Commissions,doc <br />Page 3 <br />