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APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />130G5 Oro6o Pukway - <br />763.G35.1000 <br />Reappointment to• <br />APPLICANT INFORMATION <br />Name: ~ ~~ - ~ /f';~~^ r~' ~,.~ .~ ~ ,~, City of Residence: ~ 1 ~ ~ - ~ ~_:~' <br />Occupation: ~ ~ ~c r ~r ..S f ~~ ~~ ,~ ~ ~ ,>., ~. ~ Employer: l ~ r°~ e ,,.. ~n Ic ~. < < ~ <br />Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br />board/commission for which you are seeking reappointment. <br />t y ~ y+3t F } } j ~7 <br />~ 1 2 J Z ~ S 3 f L: P ~ ~. ~ ~ M .? U l N`G-~ ~- ~'t'" tr / `Yf f~ 'J ~-- ~~ Fy @.~7 ~ [~J i ~ f"! f -~ v` (' f C .,i" ~ <br />' • ¢. <br />n ai + ~ ~. C~<. ~ S ~! . 1t ~ ~ s N ~~ C..S '4'e G .,r i f! ~' ~1 ~ S' '~ j' ,.~ ~ -~. .~' ~ te. .~ C A^f C'. ~ '~ !~`~ ~ ~ <br />/"1 t , G:'n .m vn, ~-~ Z S ~ ~ S '~°t%t .,r ~ ~ °~ ~"1 t r,F; J e~ .~ ^ ~ .~1--t L7~ ~ ~~ C ~1 ~~. ~ ~ 'Yt ~ lrn~ t' ~f <br />.~ <br />~tSrm.J~' 1 ~+`ur°r ~ <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />participation, which may be relevant in serving on this board/commirs7sion. <br />-4~~- ~ ~ 1 1 ~ fY' a=. ~' C S` G ~- f~` r~'1 ~ +'i~ (: G = ~" 1 ~ a`~ / ~'>~ ~© ~' ~ ' r <br />/(~t~~ ~_: Y~ b tt c' .~ S ~i 11e .< ~s v f ~ ~ { f-yl ,' .S +~ ~ t ~ e+~ ~'cE! s ~ f'1'j rf , {~, ~ ~' ~-e C % c' r. ~ ~ pU G , e ~ ~. , <br />(tMZ-'C.F~n ainJ~c{'.~Y~ ~r~es'~•'~-vi--e" _ ~.rF2S-~- fCt'~e'~'~ t ~rM~ ~.~ ~1S'Tiir•YSt <br />Attendance: Are your aware of the importance 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 />Comments: ~~ u z h ~ ~,-. ~ r 2_se-, + ~~ ~- ~ v c~ ,s-, 4° e ~ : ~. ~ ~'.' .~ < ~ ;~ (:.c~~ '? <br />C~ls f ~ an ~- Cam, - C.~°'1c ~ i <br />Conflict of Interest is defined as the participation in any activity, 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 you have any legal or equitable interest in any business, <br />however organized, which could be construed as a conflict of interest? ^ Yes ~ No <br />If yes, provide details on a se arate iece of a er. <br />~, <br />~. / <br />Applicant Signature Date <br />Applications will be kept on frle for one year; after that time, a new application m ust be &led. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />^ Reappointed <br />Term Expires: _ <br />^ Not Reappointed <br />