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13065 Orono 11-kwvy <br />763.635-7000 <br />AVIFL�CA TION FOR REAPPOINTEN7 TO =V <br />,ADVOSCRY R0G'R®IC0MMMMON <br />Reappointment to: _ !cf k'E Fc aur M iSsiorZ <br />APPLICANT INFORMATION <br />Name: 44- 10 City of Residence: Z A <br />Occupation: 6 L 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 />3 <br />44'c ,-38 /,`JP -5 tf ,3f66�-6 <br />=ry -V- <br />�ur�[JS�Br.I <br />ea c, l /f `d L v L v <br />lo—t Cd Gs <br />t.L } Gml�b(O,s <br />c,a) "s.5 fY"6—t- <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? CXYes ❑ 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 an business, <br />however organized, which could be construed as a conflict of interest? ❑ Yes No <br />If yes, pro detailsyn a xUrate 121ece of papet, <br />OFFICE USE ONLY <br />Council Meeting Date: <br />❑ Reappointed <br />Term Expires: _ <br />❑ Not Reappointed <br />/A—A, <br />Da e <br />fief that time, a new application must be filed. <br />