15 Appointment to boards, commissions and committees

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BOARD/COMMISSION/COMMITTEE APPY,ICATION 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 cominittees. In general, it is the City Council's policy to apNpoint persons to a maximum of two consecutive full three-year terms on a given body. In addition to th general qualifications listed in the certification below, other qualifications may be mandated by statute, ity Charter, ordinance, or resolution. Please complete th '~~~equested below and return to: City Clerk, 150 SE First StreetlP.O. Box 9037, Paris, Texas 7~. Board/Commission/Committee of Interest ❑ Airport Advisory Board ~ Building & Standards Commission ❑ Civil Service Commission ~ Economic Development Corporation ~ Historic Preservation Commission ❑ Housing Authority Board of Commissioners P.Main Street Advisory Board Candidate InformaNon Name: Address: 2 0 0 8 ❑ Municipal Band CommiQiof P'aris c~{y Clerk ❑ Paris/Lamar County Boardof Health Oplanning & Zoning Commission ❑ Public Library Advisory Board ❑ Traffic Commission ❑ Zoning Board of Adjustment 475 Work Phone: qD-~ 7Sr'✓ Home Phone: G1d?;, 'eo ~-~'-l 7 Fax: _-1D- ~ 7$4' q"? E-mail Address:_i Ir~iy1~X~ I~°{qJ1"Iot-~It,()~j •GoYbl 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. __ftaiT -ftAGEIZ ; A"17tm ~/,457-oJeI44(i P40JV ~-7 ~a~ ~ie L+U•4j'e $U1LD4,t,6 I Qi-Ai11DAA D5; - 2Cb 3 -IV V-Co 7 ZB4I i A)6 - 2eto ~ ~ f-F~5-,C.-Xr Certification 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 agee 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 ap ication. In a ce with Section 552 of the Local Government Code, I understand that information provided in this ap li ation ~~ay e a a' ble to the public upon request. Signature of Candidate: I (I ( Date: 4- 7~57 08 For Cifv Clerk's Use Only Confiict of Interest: Y/ N Indebtednessz Y/ N Nepotism: Y/ N Dist: 12 3 4 5 6 7 Previflus geriviee: 0 12 3 4 5 6 ~ City of Paris Revised 02/19/08 0 000190