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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~~it~-, recozxunended action, or decision <br />from ~vhich the individual has or could have the potential to receive personal Sain, whether it be <br />direct or indirect. (See a.tcached "Conflict of Intexest" Ordinance) <br />In accordance with this definition, do you have any legal or equitable interest in any business, <br />however organized, which could be construed as a conflict of interest? ^ Yes ~ No <br />If yes, provide details on a ~ irate ip ecc; ~„f a er. <br />~ ~ ~ <z <br />Applicant Signature Date: <br />Questions may be directed to the Administration Department at 763.635.1000. <br />OFFICE '[7SE ONLY <br />l~ New Applicant ^ Reappointment <br />/Council Meeting Date: <br />^ Appointed to: <br />Term Exp:ures: ', <br />^ Not Appointed <br />