15 Appointment to boards, commissions and committees

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BOARD/COMMISSION/COMMITTEE APPLICATION The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to serve on its standing boards, commissions, and committees. In general, it is the City Council's policy to appoint persons to a maximum of two consecutive full three-year terms on a given body. In addition to the general qualifications listed in the certification below, other qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please complete the inform ested below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas 75461. ~WdY~ed Board/Commission/Committee of Interest 'I{} v ls L:.e . LlJ U!J ❑ Airport Advisory Board ❑ Building & Standards Commission ❑ Civil Service Commission ❑ Economic Development Corporation ❑ Historic Preservation Commission XHousing Authority Board of Commissioners ❑ Main Street Advisory Board Candidate Information ❑ Municipal Band Commission Ci.tY of Paris ❑ Paris/Lamar County Board of HeRy C~erk ❑ Planning & Zoning Commission ❑ Public Library Advisory Board ❑ Traffic Commission ❑ Zoning Board of Adjustment Name: ArL-/> ~ , WtL4Dly4 Address: SitO GY 1-J _ Work Phone: 9 0 3 - 49 1 C) Home Phone: '993 ' 7$ 5 -44 Fax: 903 ` 78 5-$4,4 7 E-mail Address: (7cI1 IN tLSON @ 1~LASTICTGvAl Please note any special knowledge, education, or experience you have that is applicable to the function 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. $ ERV~~ OIJ GTy rpc11-EG L. $A'l42S, SERVED ON TII E'FOVMD I96 RDAri2.0 dF VAC~,~ UQiMG ANI) 4dvE' 8ELW ACn0Cr F30neD "r*SEft- 514(zo BF.bl~l~t►NG P~2.tS k.IJlhlG'S I~VIISSI~N !5 To ~o~t0~ _(zioAhlzr- 1-buS txfG rl~ TAEC 64-E' oE fAtVS. H-Ast AF rz,!: ~ L b~{N~ C!p - M A-N~4-G t-P Rt'W7r4 L'~R.c~ P C,~R'1'' (cS Cert ication 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 nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and shall not have any 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 I may not be appointed; however, if I am not appointed, I agree to be placed in a database for possible future notification of topics of interest. I certify that the information given by me in this application is true and correct and any false information or misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify all information provided in this app(icationlm.In accordance with Section 552 of the Local Government Code, I understand that information provided in this ap ' tion ma b v i t he public upon request. ~ Signature of Candidate: Date: For Citv Clerk's Use Only Conflict of Interest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: 12 3 4 5 6 7~Previous Service: 0 12 3 4 5 6 City of Paris Revised 08/19/08 oori2si