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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 as a conflict of interest? []Yes ONO <br />If yes, provide details on a separate pitce of 12aper. <br />Applicant Signature Date <br />Questions may be directed to the Administration Department at 763.635.1000. <br />OFFICE USE ONLY <br />D�` <br />New Applicant ❑rr Reappointment I ` a w 10+ Ltsc <br />Council Meeting Date: d* o`l IS {lllrr �-V � �3 0-0, <br />�,1,� <br />i�� p <br />'-Appointed to: <br />Term Expires: a- A <br />❑ Not Appointed <br />