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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 a Y business, <br /> however organized,which could be construed as a conflict of interest? ❑ Yes ,1No <br /> If yes,provide details on a separate iy'ece of pager. <br /> App cant Signature Date <br /> Questions may be directed to the Administration Department at 763.635.1000, <br /> application This - . new . . <br /> must be filed. <br /> OFFICE USE ONLY <br /> ❑ New Applicant 0 Reappointment <br /> Council Meeting Date: <br /> '❑ Appointed to: <br /> Term Expires: <br /> IL- El Not Appointed <br />