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<br />. <br /> <br />CITY OF ELK RIVER <br />CONFLICT OF INTEREST <br />QUESTIONNAIRE <br /> <br />Please complete this questionnaire to determine if you have a <br />conflict of interest with the City of Elk River. For purposes of <br />this questionnaire, "family member" means your spouse, parents, <br />children, siblings, brothers-in-law, sisters-in-law, and the <br />lineal descendents of any of them. <br /> <br />~. Have you or any of your family members had any material <br />interest (over $2,000), direct or indirect, in any business <br />transaction with the City of Elk River since January 1, 1992? <br /> <br />YES <br /> <br />NO <br /> <br />2. As of today's date do you or any of your family members have <br />any material interest, direct or indirect, in any pending or <br />incomplete business transaction with the City of Elk River? <br /> <br />YES <br /> <br />NO <br /> <br />. <br /> <br />3. Have you or any of your family members been indebted in an <br />amount equal to or greater than $2,000 to any vendor that you <br />believe the City does business with at any time since <br />January 1, 1992? Please exclude amounts due. <br /> <br />YES <br /> <br />NO <br /> <br />[Other questions could be included <br />as deemed appropriate by the Council] <br /> <br />I have answered the above questions correctly to the best of my <br />knowledge and belief. <br /> <br />Department <br /> <br />Date <br /> <br />You Name (Please Print) <br /> <br />. Signature <br />