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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 i� 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 />��. ��:>� � � %� �/':� ,� �.,,�; r)�i� <br />�- , � � r-�`�"�� � <br />�� <br />Ap�pl'rcant Signat�� 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@�equotlakes-mn.�ov <br />Website: www.�ec�uotlakes-mn.gov <br />Tltis� �tpplicc�i�io�� �i•ill b�- kc ��� on filr �nr one ��ectr: ufter �hu1 �in�1c u r�c�r�� rr��plic•u�io�� n�u.n�t he %ilecl. <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 />Ter� �xpires: _ <br />C:\Documents and Settings\nmalecha\Local Set[ings\Temporary In[ernet Files\OLK4\Applica[ion �orm for Bouds and Commissions.doc <br />Page 3 <br />