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APPLICANT INFORMATION {PLEASE P <br />Name: <br />Address: <br />Date of Birth: <br />City: <br />Number of years you have <br />resided in District 2: <br />State: <br />CONTACT INFORMATION <br />Phone number where you want us to contact you: <br />E -Mail address where we can contact you: <br />SIGNATURES <br />ZIP <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 or <br />false statements on this application shall be sufficient cause for voiding the application. <br />I further understand that the City of Paris will be conducting a thorough background <br />investigation that may include, but not be limited to any criminal history, employment <br />history and/or personal references. <br />Signature of Applicant �� ._ .. __ µ Date <br />