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1 APPLICATOON FOR REAPPOINTMENT TO C0TV <br /> City of ADVISORY BOARD/COMMISSION <br /> lk i <br /> i �i <br /> Reappointment to: 11d n 01V1(' C. U • Y]rSS r� N <br /> 13065 0-)"d-ay <br /> 763.635.900D <br /> APPLICANT INFORMATION <br /> Name; City of Residence: C/A- PI Veo r— <br /> Occupation:. - �r'1S Employer: s a �- n Ak <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 /> 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? X 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 n business, <br /> however organized,which could be construed as a conflict of interest? ❑ Yes WNo <br /> If y rovide d tails on a separate iece of paper. <br /> 1 <br /> pplicant ignature D e <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 />