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APPLICANT INFORMATION (PLEASE PRINT) <br />(')"L." <br />Address: <br />Date of Birth: <br />i® <br />oyloil MP ZIP <br />State: <br />j <br />Number of years you have <br />resided in District 3: <br />CONTACT INFORMATION <br />Phone-nu,Tber where you want us to contact you: <br />E -Mail address where we can contact you: <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. 1 further understand that the City of Paris will be conducting a thorough <br />background investigation that may include, but not be Hinited to any criminal history, <br />employment history and/or personal references. <br />Signature of ApplicantDate <br />. . ... ..... - <br />