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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 IeO or equitable interest in any business, <br /> however organized,which could be construed as a conflict of interest? ❑Yes ❑ No <br /> If yes,p ovide details on a es narate iec of Pape <br /> Applicant Signatur Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> This application will be I<ept on file for one year; after that time a new application <br /> MLIst be <br /> OFFICE USE ONLY <br /> ❑ New Applicant ❑ Reappointment <br /> Council Meeting Date: <br /> ❑ Appointed to: <br /> Term Expires: <br /> ❑ Not Appointed <br />