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1, APPLICATION FOR REAPPOINTMENT TO CITY <br /> City of ADVISORY BOARD/COMMISSION <br /> El <br /> River Reappointment to: L1 rarkl c Q r C <br /> 13065 Orono Parkway. <br /> 763.635.1000 <br /> APPLICANT INFORMATION <br /> Name: W D li e J6iC k City of Residence: AK •Five <br /> Occupation: Paunclerrr; ?Re ide,t COV Employer: ?felled ve resource_ /A/C. <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 /> M4 haLk qrdavki aAd bcp .6tttows m e, 40 to R,1v5 e)c se <br /> n {'� areu.s o 11/111.14 a ci etTl i e-LCALifl tv►2d <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/commission. <br /> Beinol e er++re e-ur /sma;// busiNe‘s 0W Apr lltere wit- 4unlyue skti/sa- I aniquE <br /> ,1 hi fk0J- I brit',g 4-a `Nke. 1- L € . I. n.c ve I l'ste ri v z. Adep+a1- TaraA,;q>r1 SiAtcis 3.9rateii <br /> "A"nk� 1 wend 6Ut,tfd'no fe�c��tcrn5���5 . rVic{ unicjue aaiItfj is -fro en/throe, ace -1-a.uvi <br /> q,vtno ocr. C4�ao 5 (La et. Y1eCas 0"-41 Tcuet Ofr P C\ `►Cie,. <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 any business, <br /> however organized,which could be construed as a conflict of interest? ❑ Yes ❑ No <br /> If yes,provide details on a separate piece of paper. <br /> Ll/d—'e ,ra 5(-l4 , /1- 45- Zo/a.., <br /> Applicant Signature Date <br /> Applications will be kept on file for one year;after 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 />