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APPLICATION FOR REAPPOINTMENT TO CITY <br /> City �of ADVISORY BOARD/COMMISSION <br /> RiVer Reappointment to: <br /> 13065()n..x,llatkw y <br /> %63.635.1000 <br /> APPLICANT INFORMATION <br /> l �r Name: --- ek'Ir V Z—hGr City of Residence: <br /> Occupation: r6Ai b- e d Employer: /l► ° <br /> Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br /> boar coiVtnission for which you are seeking reappointment. <br /> I+ L UG 7� 4A& r— b i <br /> bear G �C ' ` Ci ha` L� � <br /> 1; ��► '��� �' s �ve � � � ��` , is +^ `' - r"C4&N <br /> Relevant Experience: Please describe your educational, professional, civic, or community <br /> participation,which may be relev nt in serving on this board/commission. <br /> Attendance: Are your aware of the importance of regular meeting attendance including the time <br /> commitment involved in reparing for meetings, and do you feel you have the time available to be <br /> an active participant? W.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 ally business, <br /> however organized,which could be construed as a conflict of interest? ❑ Yes No <br /> If yes,provide details on a se arate ip�ece of 12al2er. <br /> k- 11- 2-14 <br /> Applicant Sig6ature 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 /> ❑ Not Reappointed <br />