Laserfiche WebLink
� 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 />� <br />� <br />If yes, provide details on a separate piece of paper. <br />� ��� �j � ���� <br />Applicant Signature <br />!��'"l� <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: speine@peciuotlakes-mn.�ov. <br />Website: www.Uequotlakes-mn.�o�� <br />.., . _ ...•.._,_.:�...,�.,,....,_._,.....�,,...,�,ti,..,,.,s.�,._.,..,,.�.�,��fs��.� <br />A��1 Yu �ui�luu�Lu.ijilk�i.� �an�r�,iruu�cuy �uaa �ii���+�nr- ---.-,------- --- <br />OFFICE USE ONLY <br />The Applicant is: New Applicant _Applying for Reappointment <br />Council Action: � Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term Eapires: <br />Notes: � r� /�.�.v �l o-f�.' — �'�1�i�. <br />- - .� �i /-�?- - � <br />C:�Documents and Settings\nmalecha\Local Settings\Temporary Intemet Files\OLK4\Application Form for Boards and Commissions.doc <br />Page 3 <br />� <br />