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13065 0.. Parkwvy <br />763.635]000 <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />Reappointment to: 90, -!'4 -of g- <br />APPLICANT INFORMATION <br />Name: )e <br />i t e. <br />mor <br />1• enj <br />e n <br />City of Residence: f 1 K <br />9; ,; e r <br />Occupation: <br />CucJ-o,nerScr.ice <br />/yo -we,_ Employer: .SK" <br />hr.4c 4•,-,e-r;e41 <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 />Sn Proceu o.f r„r'L'n(• So!!c)[i) A Ara lei 0f ync d --'e <br />-c <br />QnR fi to c f - �.ycl-e f -y.,✓ e^ r�,�'�� e D -fere. c-{- � 1t aio�7” <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />participation, which may be relevant in serving on this board/commission. <br />Rec. S• Ace oo-7 Ml, -or' c< k VL -e ctcacr �� e • S <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? UYes ❑ No <br />Comments: S hr -,e o^/— m% 1 S e -1i c e l'n r s 7 Q e c4 r s <br />/D <br />yea; s ; n 3✓!7 .wti. <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 W No <br />If �yes`provide details on a separate iece of paper. <br />- S4nyar., IS, �U/7 <br />Applicant Signature Date T, <br />App&cations 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 />