Laserfiche WebLink
JAN 2 3 2010 <br /> APPLICATION FOR REAP POI NTMENT' TO CITY <br /> City of ADVISORY IBOARDICOMMISSION <br /> El <br /> Reappointment to: X_ia_.nj._Py ^ db)-nrf1j155. "011N <br /> 1306SV, k­ <br /> 763 635 1000 111 <br /> APPLICANT INFORMATION <br /> .1 CA <br /> Marne: Clitv of Residence: (-jX de'vit'f, <br /> Occupation: fijzoex- Erriplover: <br /> Statement of Interest: Please state briefly why you are interested in continuing to Serve oil the <br /> board/cointnission for �Vhich arc scckt;rear)j­)oIntrnent. <br /> co yy)u dP4,oe) C o" I)v ? <br /> d t <br /> 64.4- 5AA00, IWMA," At�f A1104JAIJ5 <br /> APO( <br /> Relevant Experience: ])lease describe y(iur educational, professional, civic, or corrinluitity <br /> participation,xvhich_rnaV be rcL,.vantinsei ng oil this boqrd/con-itilission. <br /> j <br /> e�kfj,.�re�45 �TOA�\A51QPynolo;�4� <br /> Attendance: ,,\rc your aware of the IrriPortancc of rqnilar meeting attcridance including the tit-ne <br /> aring for niectings, and dei you feel you hhave: the finicavallable to be <br /> cotninitnient involved iiijlx�'p <br /> an active participant? e Yes Ll No <br /> conin-lents: <br /> Conflict of Interest is defined as the participation in any activity, rcconinicrided action, or decision <br /> from which the 111dividual has or could have the potential to receive personal gain, whcthcr it be <br /> direct or indirect- (Scc "Cnilflict ('f Interest" Ordinance) <br /> In accordance with this definition, do you hawk; legal or equitable interest in an5 bUSiness, <br /> I I <br /> howt-i�, ,- organized, which could be constmedas a conflict of tntcrest� L3 Yes No <br /> 1�_ I <br /> eso <br /> . y , videdctail, )n a SCDar "In <br /> atc piece (41) er. <br /> c's <br /> zxf)plicant f+i 7-nattar Date <br /> Applications will be kept ort filefor one year; after that bine: a new application must be filed. <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> 13 Real-,)poitited <br /> Terni I,1'xl-)ites: <br /> D Not Rcapl-.)oInted <br />