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13045 Orono 1arkw>• <br />763.635.1000 <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />Reappointment to: E1`IEttZI t. yY <br />APPLICANT INFORMATION <br />Name: �i b,.1 h S lGta S City of Residence: oa� 7-t.VefL <br />Occupation:'E�� eNGtv>T'%E�• Employer:Dayq !_�1y�,tosE 5t�1JC- <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 />My Fba-?t,&` 2 yPM-5. AP4 Cyosn! VG" r- , tan.ot►.>c <br />L,cot2 F t- OrL4--,) 'Cru " <br />) t vEP-- 10 -M%CP. <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? �R Yes ❑ No <br />Comments: NiayE ► Goofl Ai'CO Fez. ?AST- a cJf� <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 �3 No <br />If yes, provide details on a se arate pjece of pgper. <br />!, . � ,1��J��, <br />A$Jficant Signature Date <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 />