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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 an;business, <br /> however organized,which could be construed a �s a conflict o£interest? es No <br /> If yes, provide details on a separate piece of paper. <br /> 1-16-2015 <br /> Applicant Signature Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> This application will be ke• on • one • r r <br /> must be filed. <br /> OFFICE USE ONLY <br /> ❑ New Applicant ❑ Reappointment <br /> Council Meeting Date: <br /> ❑ Appointed to: <br /> Term Expires: <br /> ❑ Not Appointed <br />