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� <br />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 defnition, 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 />� / � ���j,G-� � r-�l l i / �.. <br />� " ��� Da e <br />App icant SigTiature t <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: speineC�uec�uotlakes-mn.�ov <br />Website: www.vequotlakes-nui.�ov <br />This crpplicution �rill (�e kept on.file,f'or a�e recu; crfter thut time u�te�r applrrcrtion nte�st be.fi/ed.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 />�..- <br />C:\Documents and Settings\nmalecha\Local Settings\Temporary Intemet Files\OLK4\Applica[ion Form for Boxrds a�id Commissions.doc <br />Page 3 <br />