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APPLICATION I T CITY <br /> City.of ADVISORY BOARD/COMMISSIO <br /> er Reappointment to: ark e" <br /> 13.065 Orono.Parkway <br /> 763,635,1000 <br /> APPLICANT INFORMATIO N "R- <br /> Name � I , City of Residence: C �✓° r <br /> Occupation: C2--le-clt(? r— Employer: b b 7 �`5 <br /> Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br /> board/commission for which y�gu are seeking reappointment. <br /> VQ, r�?[h ca co ft cu �C ' t!> ca <br /> �.0'PC3 EY(„0cr48'�^sa� �y,r� rt8+nt a"�l'._4�t°Ea c�o'i6«�� J W�`,J��.6"�i ran•_ \@l��'..d'� e:�. trJc.5:3.� �1�C°- .'� 9 eel a/'�.`y� <br /> ."�!J&+i`e� �d/1. �y'' .3;°° •�c:.7 �i1�G��i � ��../' ?,C3 :'b•1�.-S� Gx?llC 1f�6t�Jli`'`'L-?'. CRd9G' pL .�� <br /> C"i �`rn�� �ti� 6� Cre?car -i�w'stz« r ���1y <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may bi�relevant in serving on this board/co <br /> . e ssio� <br /> a4\vAkke, VU2 r �, <br /> a <br /> e4- a t'3f°®re� 1-0 re eE""PtU @dt ruLVIN�V'IA'I.�7 v v�c� C��.w,!4. col�lEc�.'_-���r``✓l..C,�l.�ti `��c?�c�t�:l°�����'c:�. . ��i.f <br /> rra,,c`a 'p <br /> � . �i.L 'a� `:•�. e�.� <br /> attendance:Are your awe of the unortance of reguar me ng attenc�aicludinhe time <br /> commitment involved in preparing for meetings, and do you feel you have time available to be <br /> an active participant? '-Yes El 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? El Yes 0 No <br /> If yes,provide details on a. arate iece of a er. <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 /> EJ Not Reappointed <br />