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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 he <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 an business, <br /> however organized, which could be construed as a conflict of interest?Dyes �No <br /> If yes, provide details on a separate piLce&paper. <br /> 2 6-[Ajr(� 7 j--- l ) -;01 -, <br /> Applicant Signature Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> This application will be kept on file for one year; after that time a new application­­ <br /> must <br /> OFFICE USE ONLY <br /> ANew Applicant ❑ Reappointment <br /> Council Meeting Date: <br /> ❑ Appointed to: <br /> Term Expires: <br /> ❑ Not Appointed <br />