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~t~rc( f-ice ll <br />- .;;~_< <br />River <br />131K5 ti„pn+1'weRw a~ <br />'GJ.G3S.IINN~ <br />APP<.ICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />Reappointment to: <br />APPLICANT INFORMATION <br />Name: 0. V1 C f' ~ City of Residence: ~ ~ ~ <br />Occupation:. ~ R Employer: t i tti ~' <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />~5~-~~ <br />Comments: <br />Conflict of Interest is defined as the participation in any activitq, 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 indirect. (See attached "Conflict of Interest" Ordinance) <br />In accordance with this definition, do ou have any legal or equitable interest in any business, <br />however organiz. e~i, which could b e conflict of interest? ^ Yes ~ No <br />If yes, provide' tails on a e ie -~'~ <br />N.Y t ~'~ <br />~,~:- ~r. ~ .,,.`yam. .+ <br />~.a" w z~., . ~ ~ ~ <br />Applicant Signa ''~. <br />~~ Date. <br />/ !~ <br />Applications will be kept on ale for ~aiie pear, after that time, a new applrcatiot~ must be filed. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />^ Reappointed <br />Term Expires: _ <br />^ Not Reappointed <br />Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br />Attendance: Are your aware of the import~e of regular meeting attendance including the time <br />commitment involved in preparing for meetings, and do you feel you have the time available to be <br />an active participant?~~Yes ^ No <br />