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APPLICATION 1 T TO�j�d�.-tll <br /> e City of ADVISORY l ' SI ��t �' �,1'�:(�f� �• �a <br /> RiVe r Reappointment to:1—KI e—l- new reksC.-e.V�� <br /> 13065 0—Parkway <br /> 763.635.100D .e"I S S/0�� <br /> APPLICANT INFORMATION <br /> P <br /> Name: oSH UA, ox City of Residence: <br /> Occupation: /��S;u ✓«,r !� � � "7 Employer: d✓�J /° �, ✓�,�ae� �i�_ <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 /> V1-rA".,.. A-A-,+i c- �v / ✓n /w / PST Q? �✓c 'f�J <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/commission. <br /> OA-). <br /> ���' d°���✓'�°��>F �S�ti�/�ms's u� ��,eN1 t/s'�✓,S,��v� �°�a� <br /> SZ. <br /> 37-A Ti C/Al/i/C Y (�66 e, <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? M Yes EJ 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? 0 Yes M No <br /> If yes,provide details on a sel2arate iece of naner. <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 /> El Reappointed <br /> Term Expires: <br /> ® Not Reappointed <br />