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APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOAR WCOMMISSION <br />306a <br />STItN1 r4,rSnanp <br />Cos sion applying far <br />Uri <br />t C_Y) 's L <br />Pi t Name <br />ast Na <br />- <br />Address <br />City a <br />State <br />Zip <br />�73 <br />V <br />Y f 4 <br />^a <br />Phone <br />Finai1 A <br />' . q o , er � Lcc�pad9in - <br />Ck <br />Public Contact Information <br />The city maintains a directory of current board/commission members on the city's website. Once <br />appointed, state statute requires members 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 life us to use: <br />❑ Horne Phone N,,,,,1,R- r 1 r.11 nt1^„p TM-T„«„t, , -maU Address <br />State btiefty why you are interested in ntinuing to serve on the board/commission for which you are <br />seeking reappointnnent: .� 0 ���k Vv. (''� W '`C' k- <br />'S Ell' %/ t V1 <br />p l C% ��rn v�C C' C�) I'Y`I `�,1 %� <br />'bll'c eks <br />_ <br />Attendance <br />Are you aware of the importance of regular meeting attendance including the time commitment involved <br />in Preparing for meetings, and do you feel you still have the time available to'be an active participant? <br />Yes ❑ No <br />Conflict of Interest is defined as the participation in any activity, recommended action; or decision-fr6m <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 rble interest in any business, however organized, which could be <br />construed as a conflict of interestzes ❑ No <br />if Yes ex lain,,gn a separate s eet o - a er. <br />plicantSignatur <br />-7--^ /J ' <br />Date <br />Board/Commission Application Page I of 1 <br />