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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 ff�o business, <br /> however organized,which could be construed as a conflict of interest?[]Yes <br /> If yes,provid details on a separate piece of 2a ear. <br /> q <br /> 21,4� <br /> r V L 51 f q 19/2V(�14 <br /> Applicant Signature Dare <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> filed.This application will be kept on file for one year; after that time a new application <br /> must be <br /> OFFICE USE ONLY <br /> \New Applicant ❑ Reappointment <br /> Council Meeting Date: <br /> ❑ Appointed to: <br /> Term Expires: <br /> ❑ Not Appointed <br />