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' % i/ % / i//�j / 1 / / %/� , J ! / ' /� j d%// '�/ ✓ ice/%iii �riii�i ri j// ; <br />r „ , ,,,,; jriiiiia�; /� ..........., //�%�... ...... rlia/, " /i.%;,%%!'�.,. �..,��/�a�,,.,. !/�iiiL, .'✓'.rG'rii�%w%!l/�f' w,„4'.iii%,'""""%// %/!� .r'�//'/'//tri%��%r�/" <br />APPLICANT <br />(PEASE PR <br />Name: INFORMATION <br />Address: 1,' -Ek f S . <br />_.... <br />Date of Birth: <br />3 <br />..C... i ty�._ `...... , _... ------- <br />State: - _ <br />Number S <br />..... <br />of years you have <br />residedin District 3: <br />CONTACT INFORMATION <br />Phone number where you want us to contact you. 2". <br />E -Mail address where we can contact you: <br />.._ _ ....... <br />SIGNATURES <br />I hereby certify that there are no willful misrepresentations, omissions or falsifications <br />in the foregoing statements and answers to questions. I understand that any omission <br />or false statements on this application shall be sufficient cause for voiding the <br />application. I further understand that the City of Paris will be conducting a thorough <br />background investigation that may include, but not be limited to any criminal history, <br />employment history and/or personal references. <br />Signature of Applicant Date <br />