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APPLICATION FOR REAPPOINTMENT TO I , � <br /> City of ADVISORY BOARD/COMMISSION <br /> fi <br /> L/,4 <br /> RiVET �� <br /> Reappointment to: p kk "'1 20 13 <, <br /> 13066 omno Parkway <br /> 763.635,1000 <br /> it <br /> APPLICANT INFORMATION <br /> Name: lylewk Ak iN cSs, City of Residence: -fit°cm <br /> Occupation:�/' �v ✓E/� � Ur�reea� Employer: iea,/es' 1,1 6V T/'a°e/i �r,,,�:, � <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 /> 0", ;t res E^� Cars Zvi s�'a c r C �';rr��i r3 <br /> .r <br /> 14,// i t, / k4 bid""m J y=r -0 . <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> partti�icipation,which may be relevant in serving on this board/commission. <br /> <<goal CIN 5 0/9 5 il"/?4 �/o�"Ye P.,' /�, t_C.✓c r'e:� y /�'itr.tst err-rr/ ��rStor t .y✓in s <br /> Ae e. <br /> d <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 El No <br /> Comments: rt a^r'� ec/ 4/1 3 tlg� r <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 4 No <br /> If yes,provide details on a separate pjece of 12gper. <br /> -A ve 1-11 /- 1--17– <br /> Applicant Signature Date <br /> Applications will be kept on file for one year,after that time, a new application mast be filed. <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> Reappointed <br /> Term Expires: <br /> ® Not Reappointed <br />