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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 in an business, <br /> however organized,which could be construed as a conflict of interest? es any <br /> If yes,provide details on a separate pjece of 12al2er. <br /> 1/31/13 <br /> p licant SiWiaturu Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> . : a a • - E � e e eo e <br /> e _ _ s <br /> OFFICE USE ONLY <br /> New Applicant ® Reappointment <br /> Council Meeting Date: <br /> ® Appointed to: <br /> Term Expires: i <br /> LJ i <br /> Not Appointed <br />