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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 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 />Applicant Signature <br />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.gov <br />Website: www.�quotlakes-mn.gov <br />'1`hi.s u/�plic•u�i��n i-rrll h� kc�p! ��n /ile /��r ��ne i�e ur: ��fler thu! tlr�ac� u netir urn/ic•u�ron n��a�s� ht� �ilc cl. <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 />S:\Sandy Documents\City Clerk\Council Meetings\2014 CC Agenda [tems\01-07-2014 Council Packet�Bruch Application.doc <br />Page 3 <br />