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05/07/2808 09:20 9037841798
<br />CITY OF pARTB
<br />BaARD/CoMnvussiuN/CoMWTrEE
<br />'~~~eWed
<br />• P'
<br />PAGE 01/01
<br />7'he P~is Ciry council fs s r,~~{~~,,~'t•.
<br />eekang comnaitted individuals v~►J~o are ~dicated ~f~e welI-bein$4f the Faris
<br />eatnmunity to servs an its standing boards, commission~, A,ad eommittees. iu gGnerat, ic :Lj be City
<br />Cuunr-il's Policy ta appdint prsrsaas to a maximum of two consecutiva fuIl threc-year t~s an ~ given
<br />bady. IA addition, to tl~c ,~et~.cral qut~lifications listed iw th.a certifica#ioaa below, ather qualificasions asay bc
<br />11~dated by st&tntc, C;ty Charter, ardinaace, or resvlution Flcase camplete the infotmatian reqvesred
<br />below aud retum to: City Clerk, 150 SE First StrecVP.O. gox 9037, paxis, Tcxas 75461.
<br />❑ Civi1 SarvlCC Commfssion
<br />BoardlGommission/Commit#ee of Iuterest
<br />~ Airport Advisory $oard o MuW,;ipa, Um$ C:o,,,xn;ss;on
<br />❑ Bui),d'mg & Staadarc3s Cammission ❑ Paris/I.amsr Coun B d f
<br />~ Economic Develapmeat Corporatian
<br />❑ Historsc preservabon Commzssion
<br />❑ Hotuing A.irlh~vrit~+ Hoard oFCommissiuu~
<br />❑ Main 5trcet Advisory soaxd
<br />Candidate Iuformation
<br />~Tame:~! ~
<br />~
<br />n► oar o Iicmtb
<br />❑ PJ.annijo.g & Zoning Conamissian
<br />Q Puhlir. LiLiruz► p,dvirary 8oard
<br />Q Tra$c Commxssiom
<br />❑ Goaing B04ti of Adlustmmt
<br />IVork Pboac: ~ Ga -71Z' ~ (o a-~ ~c~me ~bot~c: '562- 75,~ - ~o ~-I o
<br />Faz: aR - 3$ F-mail Address:_ ( G . g st" d,_ z~
<br />~-_3
<br />PJwse aiote any special 1mowledgc, education, ar cxperience you have that is applicAtc to the fiiacifoa of
<br />thc board, cammiWon, or cammitcea of intcrest (attad auiditic+aa,t pages if necewr,ry). If applic.able, list
<br />dates orservico on any City boar(h, commissioas, or commiittm.
<br />Sn s M.~ w~.or,.,~ ra l.~d r r u o!
<br />Certifictttian and AutLaritw#ion
<br />$Y sib'mnE below, l aclnowlcdgo that I am aware and :grcc to U,e prohibidong of the C9ty of ParU Clu= and t},e laws of the
<br />S[Stc 0f Tcxil,R TGg"fg 11Cp0d= 211LI GOtlfllGht n~ int4ree! of qpPqitttaos to Cily Ltuard.9, comrpissians, and cammittee6. I alo
<br />ccnify tba it appaimed 7 aill attend at lew 75 perer.nt of ail regutar meet~gS aad that2 tot hava any delinquent indebtedacxs
<br />ta 1,L1C City dtsrlilg my Lcrm. I utuicsstaa4 tlsat the Aumbcr of pasifaons ora agimn boarL commixsicm, or comsz+ittee 9s limi+w
<br />aad that I may not be appointrxt, bomever, af Y am aoe Vli,,;gcc~ I agee zo be placod ia a databago .tnr ponible futem
<br />natificzktian oftopics of intetcst. 1 catify tbat the iafamatiun givcn by ms in tW sppyWa is true and carrcct and soy fsise
<br />informatian or misrcpresmtation is cuffuarnt grwnds #br dis~liEioazion. I mnlsor3zc tha City of Pw;s tv ver;fy at1
<br />infoaaa2icm pcavidcd ia this ayplicatioy. In accarQance with Sxtion 552 of tlie Loe,g Gavemment Codr, I undersand that
<br />infolYrsxdop provided in th{s app!7~Ty bc a to thc pUblic upon request.
<br />Signature of C.Andidato:
<br />Data:
<br />~-~'!P,v Wl'MSS}CJa.N~a.C~re!.w.«a r....'....
<br />m
<br />W 000253
<br />CLO Vk%,
<br />2001200 *d 581ZU8ZE06MA) filIl838 3AI111J3K3 12 fiaf11N3] 52 :Ol (03h1)8002-ZO-66W
<br />- _-,_...--...~....,..,~.~...wr.-•~'u. or~~:?T~k,
<br />City orParit . ~
<br />R~vis~d 08/y4/08
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