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APPLICATION FOR REAPPOINTMENT TO CITY ADVISORY BOARD/COMMISSION 13065 0-- P-k—y 763.635.1000 Commission Reapplying for First Name Last Naa e i "�- Addre City L � � `� �r State N Zip Hnme PbnnP Cell Phone Email Employer Occupation I A- Co ct�-v-- � c� 1�1 Public Contact Information The city maintains a directory of current board/commission members on the city's website. Once appointed, state statute requires members to provide a telephone number, email address, or both where the applicant can be reached. This is the contact information we will include in our online directory. Please indicate which contact information you would like us to use: ❑ Home Phone Number ❑ Cell Phone Number Ymail Address State briefly why you are interested in contin g to serve n the board/commission for which you are seeking reappointment: � V, -e— �,A 7-:s v vx --� �-,-,Q— %r �& Worl,� tv k� c��-p� rS EZ �S G I be 9 ue a. � �,`r o-w\, 1,- '14 Co vtt : �S r�L °� cs �c� wee (� 0. e� C�SSi sf(a TS� e � Attendance Are you aware of the importance of regular meeting attendance including the time commitment involved aring for meetings, and do you feel you still have the time available to be an active participant? y7es❑ No Conflict of Interest is defined as the participation in any activity, recommended action, or decision from which the individual has or could have the potential to receive personal gain, whether it be direct or indirect. Do you have any legal or equitable miter t in any business, however organized, which could be construed as a conflict of interest? ❑ Yes No If yes, explain on a separate sheet of paper. �, i Y1.ti!'� i T'Q.0 x `e.0.iz�d-✓lcal �� v � � � �S a mom- �o a• qd „�\ ��,,evt-�,,- , Applicant Signature Date Board/Commission Application Page 1 of 1