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Conflict of Interest is deiined 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 />`l��uA�.. l'�'c.E'�, /l� <br />� �aa��ol� <br />Applic Signature Date <br />Questions may be directed to �he City Clerk's office at 218-�68-5222. <br />Return Completed Application to: City of Pequot Lakes <br />City Clerk <br />4638 County Road ll <br />Pequot Lakes, MN 56472 <br />E:mail: speineC��equotlakes-mn. o�v <br />Website: www.pequotlakes-mn.�ov <br />T/ti.� ct/���lirulior� ���ill hE� ke�l an_%ilr %ur nr�e rectr: e�Cter thui �rirte� u r�rc��r et/�pllc•u�io�� rvr�.�v he./ile �l. <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 Set[ings\nmalecha\Local Settings\Temporary [nterne[ Files\OLK4\Applica[ion Form for Boards and Commissions.doc <br />Page 3 <br />