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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 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 ff�o business, <br /> however organized,which could be construed as a conflict of interest?❑Yes j <br /> If yes,provide details on a separate pkce of 12al2er. <br /> Eric Johnson DNSnIYEACOYO°qW°email=EUJOM�n®EIX�erMNAa.• 1/17/2013 <br /> Dele:201J.01.ti 19:3]:19-05'W � <br /> Applicant Signature Date <br /> t <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> r - a <br /> OFFICE USE ONLY <br /> o New Applicant Reappointment <br /> Council Meeting Date: <br /> ® Appointed to: <br /> Term Expires: <br /> Not Appointed <br /> i <br />