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f <br /> t <br /> Conflict of Intere§t 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 any business, <br /> however organized,which could be construed as a conflict of interest? es No <br /> If yes,provide details on a separate 12icce of 12al2er. <br /> Ap cant Signature Date <br /> I <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> . ee • • - ce e • e • • • <br /> e - e <br /> OFFICE USE ONLY <br /> U New Applicant ® Reappointment <br /> Council Meeting Date: <br /> ® Appointed to: <br /> Term Expires: <br /> ® Not Appointed <br /> I <br />