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FROM FAX N0. 6125742049 Feb. 29 2012 11:25AM P2 <br />Conflict of Interest is defined as the participation in any acti«r3>, recozx~znended action, or decision <br />from which the indi~~idual has or could have the potential to receive personal ga' ~ whether it be <br />direct or indirect. (See attached "Conflict of Interest" Ordinance) <br />In accordance with this definition, do you have a:ny legal or equitable interest ira any business, <br />however organized, which could be construed as a conflict of iriterese.> ^ Yes ~ No <br />If yes, provide details on a s ara.te ip ece g„f a er. <br />// 7 <br />2. ~. ~~ <br />Applicant Signature Date `~ <br />Questions nay be directed to the Administration Dcpaztment at 763.635.1000. <br />pFFICE 'C.7SE ONLY <br />New.Applicant ^ Reappointment <br />Council Meeting Date: <br />^ Appointed to: <br />Tenn Expixes: <br />^ Not Appointed ', <br />