15 Appointment to boards, commissions and committees

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From: Susan Scholz, CFNP To: CITY OF PARIS Date: 4l2812008 Time: 9:49:46 AM Page 1 of 1 ~ C". ~ Bl7ARD/COMMISSION/COMMITTEE A.PPtICATION The Paris Cin? Council is seeking coinmitted individuals who are dedicated to the well-being o e Paris ~ communit,y to serve on its standing boards, commissians, and commirtees. In general, it i (,'4eEved Council's policy to appoint persons ta a maximum of hr°o consecutive full ihree-year terms on a given body. In addition to thg,general qualifications listed in the certifieation below, otiaer qualificatiorAWyow 2;;y8 mandated b}~ statute, Cit}• Charter, ordinance, or z-esolution. Please complete the information requested below and retumtp: City Glerk; 150 SE First StreetP.p. Box 9037, Paris> Texas 75461. C' Qf Pari5 mmissian/Committee of Intieres# CKr CfWC Board/Co ❑ Airport Advisory Board ❑ Niunicipal Band Commission ❑ Building & Standards Comn-iissian ❑ Paris/Lamar County Board of Health ❑ Civil Sen°ice Gommission , ❑ Plaruung & Zoning Commission ❑ Economic L3et=elopment Corporation ❑ Public Library Advisory Board istoric Preserr•at:011 CJITll]1155ior. ❑ 7raffic Coznmission ❑ Housine Authority Board of Commissioners ❑ Zoning Board of Adjustmeut ❑ Ulain Street Advisory Board Candidate Information Name: :S Ct a,n Schc>! ~ RAv -M SIV' F/I-P Address: 'a ( eD 5 ~ 1 D r h e tr~ ~ --rrs . , V4'ork Phone'.`'°i 03'_'~8 4` Home Phone.'?a 3`4-6"C( ^`76 Fax: 903 '~4 -744'0- E-mail Address: f-Please note any specia] knpwledge, education, or experience you have that is applicable to the fupction of the board, commission, or committee of interest (attach additional pages if necessa,ry). If appl'acable, list dates of service on any City boards, commissions, or comniittees. .4` I i ~ d14 t- y,e_ ~-l-n~" ~ C: Certification and Aafhorizafion By signiug below, I acl;now[cdge that I am aware and aeree to the prohibitions of rhe City of Faris Charier and the laws of the State of Teaas regarding nepotism and confilicts of interesi of appointezs to City boards, commissions, and couunittees. I also certify ihat if appointed I w-ill attend at Ieast 75 percent of aIE regu3ar meetings and shall not have any delinquent indebtedness to the City duruie my term. I uuderstand that the ntunber of positions on a given board, cvmmission, or committee is ]united and rhat 1 maE' not be appointed; however; if I am not appointed, I agree to be plaCed in a clatabase for possible future noFification of topics of interesi. I cenify that the inforination given by me in this application is true and correct and any false infarmation or misrepresentation is suff'icient grounds for disqualificaTion. C auYhorize the City of Paris to verify all infotxttation provided in this application ]n accordance tieith Section 552 of the Local Crovernme t Cod . I understand that information provided in this a lic ' n xnav b~~~aidable to the public upon reqt~est. f~~ Signature of Candidat~-~~~~~ Dace For Citv Clerk's U9e On1v Canflict, af Tnterest: Y;' N Indebted~;.ess: Y " NNepotism: Y i' N Dist:.3 23 4 5 6 7 Prer'ious Sert'ice: 0 12 3 4 5 6 City of Paris Revised 02/19148 - X 0 0255