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6.3 EDSR 01-17-2017
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6.3 EDSR 01-17-2017
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1/13/2017 1:44:28 PM
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1/13/2017 1:33:13 PM
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City Government
type
EDSR
date
1/17/2017
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SUPPLEMENT TO APPLICATION FOR <br />CONTACT! IN F,ORMAT'ION..,(publicj <br />The foRowing information will be used to contact you in the event that you are appointed to a board <br />or commission. 'fhis information is public once you are appointed and may be released upon request, <br />Residential Address: a <br />S <br />1�-z L si <br />Phone Number: -) Ce � - —2- C0 - C-i C)J", <br />AND/OR <br />Email: x'"Ce"wA 04 1 L U. 6) c, <br />ADDITIONAL CONTACT INEQRMAIIQMj(p� <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 commission, 'I'his information is -Private and will only be released to city <br />officials and city staff whose work as,sigriments require access. <br />Work Phone. <br />Cell Phone: '73,- &'b( - w`;00 <br />Other: <br />
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