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04/1512008 10:41 9037846198 <br />M. G.MIESCH MD PAGE 01!01 <br />~~f} ~1~ <br />$OARD/COMMISSION/COMMITTEE APP~~C,A-.'X'TON <br />'T'he Paris City .Council is seeking committed individuals who are dEdicated to the we11-being of the )?aria <br />community to serve on its standing boards, commissions, and committees. In general, it is the City <br />Council's policy to appoint persons tv a xxaaxitnrun o;f two caxasecutive full three-year terms on a give7o. <br />body. Iu addition to th ,general qualifications listed in the certification below, other qualifications may be <br />rnarldated by statute, ~ity Charter, ordinance, or resolution.. Please complete the infor3mation requested <br />below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas ?'5461. ~eCeiVed <br />BoarcUCvmmisaion/Committee of Intex-est <br />^ Aixport Advisory $oard <br />^ Building. & Standards Commission <br />^ Civil Service Caissiart <br />^ EGOx~on0.ic Develapmcxtt Cozporatiata <br />^ H:istoric Preservation Commission <br />^ Hvusiaag Authority Board of Commissioners <br />^ Mann Street Advisory Board <br />• A' ,! ~ 1 <br />^ Municipal Band Comuxtission "` ~ ` " <br />~l'aris/Lazxtar County Board of Healtl~~/ of Paris <br />City Clerk <br />^ Plazanimg & Zorri~ag Commission <br />^ Public Library Advisory Board <br />^ Traffic Coxtunissioia <br />^ honing Board. o Adjustment <br />~ ~ o ~~ <br />Candidate Information <br />" ~Cr !Y1 % ~G ~ ~ <br />Name: ~~~~ <br />Address. ~~p~ ~' ~~ t-cr,~~- Tom" <br />Work Phone: ! ~ ~ 7~ ~ j 1 TI Home Phona: ~~ ~ ~~ ~ ~~~ ~ <br />Fax• ~~ ~ `~~ ~/~ ~ B-zzzail Address: /~~r!!~?~,~ilblb~~tl.i~711~~./ ~~~ <br />Please note any special kzivwledge, educativzr, oz expez~ence you have that is applicable to the function of <br />the board, commission, or cornrnittee of interest (attach additional pages if necessary). if applicable, list <br />dates of service on any City boards, eoznmissions, or coittees_ <br />r'JJ//I!G''~' L 7 ~7',. ~f~/?1~~1L~.,~ `:1~/'J ~~N~+~p~,1,~~1 / <br />CertiScation and Authorization <br />By signing bclvw, 1 aclaavwledge that l ann aware azrd agxea to the pzohibitions of the City of Paris Charter and tlao laws of the <br />State of Texas regarding nepotism and conflicts of interest of appointees to City boards, eornmissions, and eommittees_ l also <br />certll'y that if appointed 1 will attec;d at least 75 percent of all regular meetings and shall riot have any delinquent indebtedness <br />to the City during my term. 1 understand #hat the number of positions on a given board, cornrptxssloxa, or c4r3auaittee is limited <br />anal that I may not be appointed; however, , if I ana mot. appointed, l agree to, be planed in a database for possible futons <br />notification of topics of interest. I certify that the information given by me izr tkuis applieatioxx is true and correct and any false <br />irrfoxznation or ruisrepresentation is sufficient grounds £pr disqualification. I authorize the City of l'aras to verily all <br />juafoz~o;rataoz~ providcd i:a this c 'o . In aceo7rdar~ce with Section, 552 of the Local GovetYrment Codc, I understand that <br />information provided in this a y available o the public upon request. t J /~ <br />Signature of Candidate: Date• 7" / J `'~~ <br />City of ~a~s <br />i~~, <br />~ ~~ ~~~~ <br />~~ <br />U1 J~ <br />Rtrised 02/19/08 <br />~~~---~~ <br />