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I <br /> I <br /> Conflict of Interest is defined as the participation in any activity,recommended action,or decision <br /> from which the individual 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 m.,any business, <br /> however organized,which could be construed as a conflict of interest? 0 Yes No <br /> If yes,provide details on a sel2ara te pip se of paper. I <br /> J <br /> App n*Situ-re Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> OFFICE USE ONLY <br /> ® New Applicant U Reappointment <br /> Council Meeting Date: <br /> Appointed to: <br /> Term Expires: <br /> El Not Appointed <br />