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0 <br />Fill,�:i�:zlolil"k�ld'zl:l�,k9�bm,t*X;Ilbr,,At-ILS]I <br />CONTACT INFORMATION (py�bfic <br />The following information will be used to contact you in the ei,-ent that you are appointed to a board <br />or corrin-iission.➢lus information ispublic once you are appointed and may be released upon request. <br />Residential Address: i S6 2- <br />A-j <br />phone Number: <br />AND/Olk <br />Ernait J4117r?cLr <br />ADDITIONAL CONTACT INFORMATION (private) <br />Please provide any additional contact information that can be used to contact you in the event you <br />are appointed to a board or cointi-iission. This information is pfimle and will only be released to city <br />officials and city staff whose work assignments require access, <br />Work Phone: <br />,Cefl Phone: 6, N z, .- �,n o - I:LYS ! <br />Other: <br />