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Confllet 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 inditect. (See attached"Conflict of Interest"Ordinance) <br /> In accordance with this definition,do you have any legal or equitable interest in an business, <br /> however organized,which could be construed as a conflict of interest? es No <br /> If yes,provide details on a qeparat e piece of a er <br /> av�-- 1/24/2014 <br /> A c t Qnalure Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> OFFICE USE ONLY <br /> New Applicant 0 Reappointment <br /> Council Meeting Date: <br /> El Appointed to: <br /> Term Expires: <br /> ® Not Appointed <br /> i <br />