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APPLICATION FOR REAPPOINTMENT TO CITY 1 <br /> City of ADVISORY BOARD/COMMISSION <br /> Elk <br /> RiVer Reappointment to: <br /> 13065 Orono]Wk—y <br /> 763.635.1000 <br /> APPLICANT-INFORMATION <br /> Name: Ald C�J))City of Residence: <br /> Occupation: Employer: <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 rea pointment. <br /> Relevant Experience:T'lease describe your educational,professional, civic, or community <br /> participationqWZCU.jay be relevant in serving on this board/commission. <br /> ov <br /> 41 <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? 9Yes ❑ 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 an business, <br /> however organize hich could b construed as a conflict of interest? L] Yes TO <br /> If rov de ils a ar e pjece of 12al2er. <br /> Applicant 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 />