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Conflict of Interest is defined as the participation in any activity, recommended action, or decision <br />from which the individual has or co~.ild 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 ~o <br />If yes, provide details on a se arate iece of nab r. <br />;~'7f~ 1 ~-'~-f -' ~ <br />-~ <br />pplicant Signatures--~ Date <br />Questions may be directed to the Administration Department at 763.635.1000. <br />OFFICE USE ONLY <br />New Applicant ^ Reappointment <br />Counal Meeting Date: <br />^ Appointed to: <br />Term Expires: <br />^ Not Appointed <br />