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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? i� Yes No ��� ��7- _ �F' � U/yJ.� <br />If yes, provide details on a separate piece of paper. �'���'" '`'6 sar'k'o,�.� � ,� <br />�� %+na � � � �r✓' % �res� �Y�nc l��7 Ji✓ C O/l <br />��°✓/� ,d/.S�c>sS�,_,�5 /j.� N<,.c��1' <br />� V l�I �°��T �2� ZO / 2. <br />Applicant Signature Date U <br />� <br />� <br />Questions may be directed to the City Clerk's office at 218-568-5222. <br />Return Completed Application to: City of Pequot Lakes <br />City Clerk <br />4638 County Road 11 <br />Pequot Lakes, MN 56472 <br />E:mail: speine@pequotlalces-mn.�ov <br />Website: www.peauotlakes-mn.�ov <br />fljrl�yr�n��r�41��r�l��y��y1 ii'��s�'��aur��r��i1'I r�t���i�r�:�y4n�r�r�i�a��l��e���19rr�'�muu�y��riii7�l�nhl�i��ne����rrii�?1'(a�li <br />OF'FICE USE ONLY <br />The Applicant is: New Applicant _Applying for Reappointment <br />Council Action: Not Appointed <br />Appointed to: <br />Date Appointed: <br />Term Expires: <br />Notes: <br />C:�Documents and Settings\nmalecha\Local Settings\Temporary Inteme[ Files\OLK4\Application Form for Boards and Commissions.doc <br />Page 3 <br />