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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?Dyes <br /> If yes, provide details on a separate piece of paper. <br /> Teri A Flatland "` <br /> 08107!2014 <br /> pw;nee.t.4 F41-w6N MtlGa 6--SD Ida. <br /> .so�nv wr-0 ...z us <br /> Applicant Signature Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> application This on • • • <br /> must be filed. <br /> OFFICE USE ONLY <br /> XNew Applicant ❑ Reappointment <br /> Council Meeting Date: <br /> ❑ Appointed to: <br /> Term Expires: <br /> ❑ Not Appointed <br />