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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 inditect. (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 ?aes No <br />If yes, provide details on a separate piece Q j2QCT. <br />a 1 <br />! '% <br />Applicant Signature Date <br />Questions may be directed to the Adrnirxistration Department at 763.635.1000. <br />OFFICE USE ONLY <br />❑ New Applicant ❑ Reappointment <br />Council Meeting Date: <br />❑ Appointed to: <br />Term Expires: <br />❑ Not Appointed <br />