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APPLICATION FOR REAPPOINTMENT TO CITY <br /> City of ADVISORY BOARD/COMMISSION <br /> Elk <br /> R1Ver Reappointment to: <br /> 13065 Or—I,.,,-I ay <br /> 763.635.1000 <br /> APPLICANT INFORMATION <br /> Naine.-foizz'a ave ,5 City of Residence: 4�Mi 1�k" 141y <br /> OccupationV�-yM (-A� M/. AYM-- Employer: 'lYL0VW5Ns <br /> Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br /> bo2ld/conirrivsion for whichou are seekin ea pointmen <br /> - u <br /> N WEIR 5- 110ham <br /> m Ar IzOOM IN AA i NN W7DT7A <br /> Relevant Experience: Please describe your educational, professional, civic, or community <br /> tici ation w ch ma be rel want in servin on this board/commission. <br /> � 1t <br /> W: <br /> OPP/ o tea. t.�5 WITH <br /> ttPnd e: ee)Xo �a�— <br /> ae` importance of regular meetVuig attendance including the time <br /> commitment involvedin repaying for meetings, and do you feel you have the time available to be <br /> an active participant? ?Yes ❑ 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 any business, <br /> however organized,which could be construed as a conflict of interest? Ll Yes �(No <br /> If ye .provide details on a separate piece of paper. <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 /> Terin Expires: <br /> ❑ Not Reappointed <br />