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NUV u 8 2022 <br />APPLICATION FOR REAPPOINTMENT TO CITY ADVISORY <br />BOARD/COMMISSION <br />Commission Reapplying for ,� y <br />14, iµ m <br />--- ........ .. - . - ......... .... <br />First Nam <br />) E �)�.a <br />LastName, <br />... „ <br />Address -.,, -.-1 <br />' / <br />a <br />Ci St�... <br />t E \ at� <br />.... ..m ...- <br />Home Phone Cell µPhone -� - -LL- <br />ccupation <br />- -- <br />Employer rO <br />Email <br />µ 6i. <br />Zip <br />w <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 °ti�ou would like us to use: <br />Home Phone Number <br />State briefly why you are interest <br />ed <br />seeking reappointment: <br />ell ov 41 &1 <br />Phone Number II w fEmail Address <br />in'continuing to serve on the board/commission for which you are <br />Attendance <br />Are you aware of the importance of regular meeting attendance including the time commitment involved <br />in reparin for meetings, and do you feel you still have the time available to be an active participant? <br />Yes MNo <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 interes in any business, however organized, which could be <br />construed as a conflict of interest? ❑Yes No <br />". <br />If ryes, exrdain on a separate sheet of f}aper. <br />If you do not wish to seek reappointment, lease check th y pp , p e below box. <br />0I do nrpt wish to seek reappointment. <br />cant <br />Date <br />Commission Application Page 1 of 1 <br />