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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 any business, <br />however organized, which could be construed as a conflict of interest? U Yes [A' No <br />If yes, provide details on a separat of Val2er. <br />-2 <br />Applicant Signilture Date <br />Questions tnay be directed to the Administration Department at 763.635, 1 Oft <br />The Applicant is: Q New Applicant U Applying for Reappointment <br />Council meeting date: <br />L3 Appointed to: <br />Term Expires: <br />U Not Appointed <br />