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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 anv business, <br /> however organized,which could be construed as a conflict of interest?aes ✓ No <br /> If yes,provide details on a sel2arate pigge of 12al2er. <br /> @,4ry Dl:cn=slOnedbybder @d11.wm d101.com 02/11/2014 <br /> brian.ballen er di i.ConI.DN:cn014.0.111 :23:05g 6'00' <br /> I D9ta;2014.02.11 10:23:05.06'00' <br /> Applicant Signature Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> OFFICE USE ONLY <br /> D New Applicant D Reappointment <br /> Council Meeting Date: <br /> D Appointed to: <br /> Term Expires: <br /> D Not Appointed <br /> i <br /> i <br />