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Conflict <br /> � lllacreis i ast elms. ps the parkcip ati n in any activ�it iec(,:)r ir,ended Faction, or decision <br /> ftorn 'hatc <br /> ail li as or coa ld have the yquitia.l to receive l-pergo i al g iT yathcther ite, <br /> direct or indirect. (See amached "C otifficf of Interest" Ordinance:) <br /> In accordance vith 9lais definition, do you lams lr any a e.mt cclAta1_ale inter rst:in any business, <br /> however er o:a:gatp zed,whiich crpUld beco nstru.cd as saconfli.ct of interest-PV Yes Fh�ca <br /> If e°s 1pzurpvicle lerads on a sa aaprata crv� c:rf911Per. <br /> ,m <br /> __._......_.__. 6,;/Was <br /> Applicant. Signature 1,`7matc <br /> Qucstiaaat.s may be directed to the Admiia.i,str;ation I.ep,,irt:ment at W6311 O. <br /> AAMM <br /> sm, <br /> OFFICE USE ONLY <br /> cpm'~✓ A pplicam Reaippoiai:tmerit <br /> (:caeliacil Me tiri,D"atc: <br /> Ll A ppoir ted t' : <br /> Term Flxpircs� <br /> N'ot Appointed pointe d <br />