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APPLICATION FOR REAPPOINTMENT TO COTY <br /> City of ADVISORY BOARD/COMMISSION <br /> Lk. —`—� IV <br /> 1 3065 0—11-k—y Reappointment to: El �Y l ��1� r l"' <br /> 763.635.1000 <br /> APPLICANT INFORMATION <br /> Name: EAXL-� 0 j18061r City of Residence: �e�t <br /> Occupation:C-ZA tS7 }('Tt d h) �dL Employer: ( [C)M 44 <br /> Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br /> board/commi lion for which you are seeking reappointment. <br /> 1 C'_A11 P� ,� WS-R)PICAL (",0A)' ; CAy Ass'&z Tgt rmA�T <br /> 6 e= +hr-P{L y uq Ac4 6 V (3 m-) --rHc Ac fL l t all-t L-b a ,W,Cc we <br /> Relevant Experience: Please describe your educational, professional, civic, or community <br /> participation,which may be relevan in serving on this board/commission. <br /> 3s 4 , ;AJ pal` � �' C c1 rt7 �/a r1t FA�� 'k'. t c30 !-[1'6 <br /> A-'i 00 t kncsitl ' 9,6, Uut).AQU :�0,5A-=0- SDP_..' Ali dF/V ct'fz <br /> � +�S 'old►V `Ti�� �5 /vJ n/ F��Lr�rtJ7 ���u C'�-��c�� <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 L3 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 accor ce with this definition, do you have any legal or equitable interest in any business, <br /> howev r or nized,which could be construed as a conflict of interest? ❑ Yes *No <br /> If s, ro de details on a 'at iece of a er. <br /> X6 <br /> Ap licant Si Date <br /> plications ' be kept on file for one year;after that time, anew application must be filed. <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> ❑ Reappointed <br /> Term Expires: <br /> ❑ Not Reappointed <br />