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u~, <br />~. <br />~ln,~., <br />River <br />13065 Orono Pazkway <br />763.635.1000 <br />rC:;t~C~- i- c ~- i i <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />Reappointment to: [~ ~ `~ ~~~ ~~~``~I°~°~~~ - ~, SE ` ~. f <br />1 <br />APPLICANT INFORMATION <br />1 _ <br />Name: ~ ~4 ; ~ ,~. ~ ~' ~ ~ ~ tY ~ ~..-~ ~ E ~~~~'~ <br />`~ t E ~~ ie V` Ci of Residence: <br />Occupation: L '~ ~ ~°~ ~ Employer: (~- <br />F <br />Statement of Interest: Please state briefly why you axe interested in continuing to serve on the <br />board/commission fox which you axe seeking reappointment. <br />..~ <br />f ~~ ~~e.lr~wt -c A ~ ~ s~ ~ ~ a ~ r ~ #~; ~.~r~~c? ~ ~~t '~ ~~~t r~-~ c s S E ~ t.-~ <br />I o FZ E ~ ~ ~~ ~ t'~,•.t c~`,~~-~ dAv~ ~ ~ ..-~ ~ ~ ~ ~ c~ A~ ~'f~ [ ~ ;rlr.1 ~ ~'~ ~ L i Tl ~~'r <br />~t~ 1-4 ~ 1 f F ~ r! ~ ~ i '~`(~ °j e~ [~~iL~'~ ~ th J~ f Z.~ 1 ~ (R~°'~"~.~ y~,i ~.t ~ t ~ U <br />~Z. ~ ~ i LO ~~ D ~A tc,~ ~' ~~r n ~T ~!~-~ P~2~' ~ rtin..ix s r ~~ ~..ti~Yi <br />Relevant Experience: Please describe pour educational, professional, civic, or community <br />anticipation, which maybe relevant in servin on this board/comx~nission. <br />~~~/~.~ ~r ~c~ J~'~-- ~ ~C i c. i ~, ~itf r ~ ~ ~ts~ '~~~ ~~r`L.K ~ t.! f., (~ <,~l <br />~Dre c'.t~tne.1 ~/~~-~~ ~nf lAt, 9~i~"e"'~Stt`~rl j~[ ~~G,nj~~ ((Z ~'~`i~ ~~C; I~' ~G <br />- ~ <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: <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 an business, <br />however organized, which could be construed as a conflict of interest? ^ Yes No <br />If.es, provide details on a se arate iece of a er. <br />;'~ A `plicant Signature ~ Date <br />~~~~ <br />Applications will be kept on file for one year; after that time, a new application must be frled. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />^ Reappointed <br />Term Expires: _ <br />^ Not Reappointed <br />