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s <br /> APPLICATION PP I T °T TO CITY <br /> City or ADVISORY BOARD/COMMISSIO <br /> RiVer Reappointment to: , r n TbDatrCL <br /> 13065 Orono Parkway <br /> 763.635.1000 <br /> f <br /> APPLICANT INFORMATION <br /> Name: 7i Cep M le e iCl i-t� City of Residence: <br /> Occupation: &A 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 /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/commission. <br /> Z ,6t!?�16 Al'? -fin IF ZJ @ iV }/P cr-e_.c.-r Ac h— %o %P'S <br /> C04- C&kr- <br /> Attendance: Are your aware of the importance of regular meeting attendance including the time <br /> commitment involved in paring 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 UXINo <br /> If yes,provide details on a separate pjece of 12al2er. <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 /> D Not Reappointed <br />