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Conflict of Interest is defined as the participation in any activity, recommended action, or decision <br />frorn 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�&o <br />business, <br />however organized, which could be construed as a conflict of interest?,Yes <br />I e oxide detail on a se crate lace of a er. <br />� �� � dare. <br />s24. .Com �°�°�®�°,-,Rust. RT on January 11, 2096 <br />Applicant Signature <br />Data. <br />Questions may be directed to the Administration. Department at 763.635.1000. <br />OFFICE USE ONLY <br />XNew Applicant ❑ Reappointment <br />Council Meeting Date: <br />❑ Appointed to: <br />Term Expires: <br />❑ Not Appointed <br />