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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 />� <br />� <br />If yes, provide details on a separate piece of paper. <br />, � , �. , <br />; , , �✓ r/. <br />��.�.,/r„ � � _ �- �._--. <br />plicant Signature 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@peauotlakes-mn.�ov <br />Website: www.neauotlakes-mn.�ov <br />This applicutrc» ��rill be kept o�2 frle fof• nne �'ear; « fter thcit trnte cr netir cip��lirntion nnrst 1�e.filecl. <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 />C:\Documents and Se[tings\nmalecha\Local Settings\Tempora�y Internet Files\OLK4\Application Form for Bou�ds arid Commissions.doc <br />Page 3 <br />