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APPLICATION FOR REAPPOINTMENT TO CITY <br />ctr_f (�A6 ADVISORY BOARD/COMMISSION. <br />•ver Reappointment to: -Zl-fekr 7 C. '] ui?i t'`6LV1 <br />131365 Oro Parkway <br />763.635.1000 <br />APPLICANT INFORMATION <br />Name: lekY4 City of Residence: <br />Occupation: ,f�l�L �' Employer:�r �. e a r <br />fs <br />Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br />booard/commission for wl }ch you are, seeking reappointment. , a <br />0.i`%t� �f U•cS< <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? 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 any business, <br />however organized, which could be construed as a conflict of interest? ❑ Yes LiNo <br />If yes, provide details ona se aratepiece of 12aper. <br />/ /Z -,f/ <br />Applicant Si tore Date <br />Applications will be kept on file for one year; after that time, a new application must be fled. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />® Reappointed <br />Term Expires: _ <br />13 Not Reappointed <br />