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' APPLICATION FOR REAPPOINTMENT TO CITY <br /> City of ADVISORY BOARD/COMMISSIO <br /> amft <br /> River way Reappointment to: Y )v o y p <br /> 130650....Yack <br /> 763.635.1000 <br /> APPLICANT INFORMATION <br /> Name: City of Residence: J <br /> Occupation: Employer: <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 /> :^rju ` /j ✓ �'���° �1� Y`t�i� �° 1 �� 6^ o a/ l e �JY,q t om/ ar, a r,,too�j c� Y?"� <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/commission. <br /> pp , <br /> �j0e?'r , a''YaLa�+�z'� dEf deld.s � �®3eli ! '°��r ! �� ►✓� <br /> U0lur, w ... , 1 yep Vy t..1/� ,A 66r g VA --ys lVe.1 e yl pvk 2 <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 /> tt <br /> Comments i /i A oc c a, <br /> Conflict of Interest is defined as the participation in any activity,recon- -vended 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? El Yes No <br /> If yes,provide details on a se arate iece of a er. <br /> Applic nt Signature Date <br /> Applications will be kept on file for one year,after that time, a new application must be filed. <br /> i <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> El Reappointed <br /> Term Expires: <br /> EJ Not Reappointed <br />