15 Appointment to boards, commissions and committees

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Rpr 14 08 09:53a Lamar Natl.Bank 903 784 6222 p.Z BOARD/COMMI5SION/COMMITTEE APPY,ICATION The Paris City CounciI is seeking committed indivictuals who are dedicated to the well-being of the Paris community to serve on its standing boards, comrnissions, and committees. In general, it is the City Councii's policy to apyoint persons to a maximurn of two consecutive full three-year terms on a given body. In addition to th ,general qualifications listed in the certifcation below, ather qualifications may be mandated by statute, ity Charter, ordinance, or resolution. Please complete the information requested below and return to: City C1erk,154 SE First Street/P.O. Box 9037, Paris, Texas 75461. ReCeived BoarcUCommission/Committee of Interest ❑ Airport Advisory Board ❑ Building & Standards Commission , ❑ Civil Service Commission Ei<onomic Development Corporation ❑ Historic Preservation Commission ❑ Housing Authority Board of Commissioners ❑ Main Street Advisory Board Candidate Information ~~'F, 2~08 ❑ Municipal Band Commission ❑ Paris/Lamar County Board of HealGLdy Of P8t'IS ❑ Planning & Zaning Commission G14y ClerPt ❑ Public Library Advisory Board ❑ Traffic Cozxunission ❑ Zoning Board of Adjustment Name: f'c,,A,~d L-- Q,a J c-ar r.o v, Address: 3 o g 5 N'`0J,,,_ -C ~5,t, p111i" s o WorkPhone: q ff3 _2F S'C?74 k , li ax: * 78 q- (a a a Home 3q a ~A s Wa'i`►A+~r~.c 0~ E-mail Address: Se.vcrio wC) ~ Please note any special knowledge, education, or experience you have that is applicable to the fiinction of the board, commission, or committee of interest (attach additional pages if necessary). If applicable, list dates of service on any City boards, commissions, or committees. 200 z Jv~ 200$ _ _ CerEification and Authorization By signing below, I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the State- of Texas regarding aepotism and conflicts of interest of appointeas to City boards, commissions, and committees. I also certify that if appointed I will attend at least 75 percent of alt regular meetings and shatl not have aay delinquent indebtedness to the City during my term. I understand that the number of positions on a given board, commission, or committee is limited and that 1 may not be appointed; however, if I am not appointed, I agree to be placed in a database for possible futtu'e notification of topics of interest. I certify that the information given by me in this apglication is true and conect and any false information or misrepresentarion is sufficient grounds for disqualification. I authorize the City of Paris to verify all information provided in tkiis application. In accordance with Section 552 of the L.ocal Government Code, I understand khat information provided in this ap = be =ailable to the pubIic upon request. Signature of Candida.te: "r Date: ( S40e Ear~' Cier-k,~,~se~_~ Contlict of Interest. / ~1 Indebtedi~ess., / N NepQttsm: Y /~1' bis'.t. 1 2..~:'~ ~7: ~'~V~}1~~~'►'~4~; ~ ~ City of Paris _ 000256 Revised 02/19/08