Laserfiche WebLink
~'t_;u'i~ 1r~2 _C) <br />fiver <br />13065 Orono Pukway <br />763:635.1000 <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />,-. <br />z~,~ <br />~' ! G <br />Reappointment to• ~~--r~--~ ~ I~.C ~ 1.~"~~~~-S~ `~~``~ <br />APPLICANT INFORMATION <br />Name: ~ i ~, 1V +z1i'6 t~-K City of Residence: ~~ ~C. ~ ~ t~Gr' <br />Occupation: ~~-~ Employer: ~`~ ~ ~ ~ 2 g <br />Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br />board/commission for which you ar/e seekin reap ointment. <br />~ 1p,~1 ~ t.~,.z -~e.- ~ ¢l~~t' ~ ~~ .~..,,~ Jy k TS ~ ~~~ ca~~s <br />Av~.2rti ~-o o wr- ~w,r+a.wwr e}-rea. U,rC, ~Iu., a or^~-ur~, - <br />fix- ~' K.~-wti ~, ~~n~,s <br />oyee.S <br />{ <br />r; , et,s <br />~n~"aneeQA~re y~ourl aware of'~the ~p~SrL`tan So~egL~ilar 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? 1~•Yes ^ No <br />Comments: <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 defuution, do you have any legal or equitable interest in any business, <br />however organized, which could be construed as a conflict of interest? ^ Yes 1~ No <br />If yes, p o e details on a e arate iece of a er. <br />` 1 1 ~l <br />Applicant Signature Date <br />Applications will be kept on file for one year; aftet that time, a new application must be filed. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />^ Reappointed <br />Term Expires: _ <br />^ Not Reappointed <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />articipation, which maybe relevant ~' "serving on this board/co ssion. / <br />11a.~ De.ean QSS~''S`t-i v,~ eo~Mv~-u_wv P~C.,oi~-fie au <br />