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b * �/ <br />City of <br />Elk - <br />River <br />13665 0-- P-kway <br />163.635.1000 <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />JAN 3 0 2020 <br />Commission Reapplying for <br />First Name <br />Last Name <br />AMO% <br />So L~T VEl]% <br />Address <br />City <br />State Zip <br />Hoine Phone <br />I Cell Phone <br />Email <br />Employer <br />Occupation <br />A-r+owA- Ceanr47 e2/t-S <br />nPt''YtMy�.vs Q ✓isl>o� sc2✓�G63 /"�q.•�/t�t'ti'� <br />Public Contact Information <br />The city maintains a directory of current board/coininission ineinbers on the city's website. Once <br />appointed, state statute requires inernbers to provide a telephone number, email address, or both where <br />the applicant can be reached. This is the contact information we will include in our online directory. <br />Please indicate which contact information you would like us to use: <br />.rHoine Phone Number ❑ Cell Phone Number ❑ Einail Address <br />State briefly why you are interested in continuing to serve on the board/coinimission for which you are <br />seeping reappointinent: <br />r A —I P4-51*&wV *ec .4eo✓Y e6"-r,,j.""V` Te /MPR.aulr 79*tF" <br />OPPbM-rJNI1/6i A✓HVfL.AF$LA PN 7L4e e.—FV .• r wav,* L.0,;6" To <br />N07Lp,, " i.l <br />Attendance <br />Are you aware of the importance of regular ineeting attendance including the trine coinimitinent involved <br />in preparing for ineetings, and do you feel you still have the time available to be an active participant? <br />.rYes ❑ No <br />Conflict of Interest is defined as the participation in any activity, recommended action, or decision from <br />which the individual has or could have the potential to receive personal gain, whether it be direct or <br />indirect. Do you have any legal or equitable interest in any business, however organized, which could be <br />construed as a conflict of interest? ❑ Yes ZrNo <br />If yes, explain on a separate sheet of paper. <br />Applicant Signatur <br />y z02.0 <br />Date <br />Board/Commission Application Page 1 of 1 <br />