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f, <br />Conflict of Interest is defined as the participation in any acti~rity, recommended action, or decision <br />from which the indi~ridual has or could have the potential to receive personal gain, whether it be <br />direct or indirect. (See attached "Conflict of Interest" Ordinance) <br />In accordance with this definition, do you have any legal or equitable interest in an business, <br />however organized, which could be construed as a conflict of interest? ^ Yes ~No <br />If yes, provide details on a se_ al rate iece of a er. <br />~ -11 ~ ~~, 20l ~ <br />pplicant Signature Date <br />Questions maybe directed to the Administration Department at 763.635.1000. <br />OFFICE'USE.ONLY •s <br />-~~~ ~ r:~.:.. <br />^ New App~icaiit ~~ ~' ~~~^ Reappointment ~ ~ _ " <br />Council Meeting Date: <br />.. .: - <br />.. ~ ~-, . , <br />:- , ~ . ~ n , <br />. , a ., , <br />,, ,, <br />r ~; ; <br />., ~ 4 ~ - <br />; <br />P , <br />.. <br />~' _. <br />.. <br />¢: <br />>. <br />