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APPLICATION FOR APPOINTMENT TO EDA <br />City of <br />Elk AND HRA SUBCOMMITEES <br />Subcommittee Applying For: <br />RiV6r <br />13065 Ox Pa kway <br />763.635.1000 <br />APPLICANT INFORMATION <br />Name: J l <br />$ rcA <br />City of Residence: <br />/Y% e. <br />Occupation: c <br />p✓nP5+ <br />Employer: W <br />n <br />Statement of Interest: Please state briefly why you are interested in serving on the subcommittee <br />for which you are submitting this application. <br />s A A I <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />participation, which may be relevant in serving on this subcommittee. 01 <br />/� /��+ ri�7.G�Jr.1.CG ��erlf �/.e.L .�rJ�'r�is __!�i ..clf'�[. •�G �� <br />Attendance. Are your aware of the importance of regular meeting attendance including the time <br />commitment involved in preparing for meetings, and do you feel you have the time available to be <br />an active participant?, 'Qes ❑ 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 siness, <br />however organized, which coup con <br />ied as a conflict of interest? ❑ Yes No <br />If ve v1 detail&-,6h a <br />A <br />OFFICE USE ONLY <br />paper. <br />Date <br />Representation on Subcommittee (ie: legal, realtor, etc): <br />❑ Appointed to: ❑ Not Appointed <br />