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Conflict of Interest is defined as the participation in any activity,recommended action,or decision <br /> ii from which the individual has or could have the potential to receive personal gain,whether it be <br /> r direct or indirect. (See attached "Conflict of Interest" 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?aes ✓ No <br /> If yes,provide details on a separate Rigce of 12al2er. <br /> Applicant Signatu e 0 Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> MENEMM • • oo •IM <br /> OFFICE USE ONLY <br /> )4 New Applicant L1 Reappointment <br /> Council Meeting Date: <br /> ® Appointed to: <br /> Term Expires: <br /> ® Not Appointed <br /> i <br /> f <br /> i <br /> i <br /> i <br />