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05/06/2008 23:52 FA% 909 785 0470 BALLARD INS 2002 <br />BOARD/CQ►MMISSION/C(~MMITTEE APPILCCATION <br />The Fsris City Council is seeking committed individuals whu are dedicatecl to the we11-1yeing of the Paris <br />community to serve on its standing boards, commissions, 111d CO117Y]311tCC5. In generaX, it is the City <br />Cotuacil's policy to appint persons to a maximum of iwo consecutive full three-year tezms on a given <br />body. In addition to th genexaX qualifications lxsted in the cerfification below, other qualifications may be <br />mandated by statute, ily Charter, ordinance, or resolution. Flease complete the informa.tion requested <br />belorv and return to: City Clerk, 150 SE Fizst Street/P.O. Box 9037, Paris, T'exas 75461. <br />BoardlCommission/Committee af Interest <br />❑ Airport Advisaary Board <br />ZBualding & Standards Cammission <br />❑ Civil Service Commission <br />XEwnomic Develapment Corporation <br />~ HiStoric Preservatibn COxxunission <br />❑ Ho'using Authority Board pf Conunissioners <br />❑ Main Street Advisozy Board <br />Candidate Infornuatran <br />❑ Municipal Band Commission <br />❑ Paris/Lamar County Board af Health <br />❑ plann.i,ng & Zoning Commission <br />❑ Fublic Library Advi,sozy Board <br />❑ Traffiic Cammissian <br />❑ Zoning Board of Adjustment <br />Name• ~/1 GKt 6AL-LAR..N <br />Address: L ~ e/ ' 9151 .V-1.5-`~ <br />Work Phane: `y q~J' 0 ~D Illome Phone:~.v 3 -7 $`"I ' ca~ 1 -7 2 <br />Fax: 5,5• 0 'rf p E-mail Address: UIGK / ~ &9&ff17IN5URAN(_'&• NEr <br />Please note any special knowledge, education, or experience you have that is applicable to the fiwctidn of <br />the bdard, commission, or commxttee of interest (attach additional pages xt' aecessary). If applicabXe, list <br />dates af service on any City baards, commissxoms, or eommittees. <br />o ~8~c iti ~ZMaMAL WIROW od, <br />Certffication and Autharization <br />By signing below, I acknvwledgc thtu T am aware and agree to the prnhib'rtions af the City of Paris Charter and the laws of the <br />5tate af Texas regarding nepotism and conflicts of iaterest of appoi:►tees to City boards, eommissions, and cammittees. I also <br />certify that if appointed I will attend at least 75 percent of ali reguiar meetings and shall n ot have any delinquent indeb#ednes5 <br />to the City during my term. I underscsnd th9t the munber of positions on a givpn board, commissian, or committee is limited <br />and tltat 1 may not be appointed; however, if I am not appointed, I agree to be placed in a database for possable firture <br />natifioation of topics of initerest T certify that tbe information givem by me in this applicsction is true and carrect and any faise <br />ipformation or misrepresexitation is sufficient grounds for disyualifiastion. I authoriu the City of Paris to verify all <br />information provxded in chis a'cation. tn accordance with Section 552 of the Local Uovemment Code, I understand tbat <br />infvrmstion provided in this a ay vailable w the blic upon request. <br />Signatiure of Candidate; Date: 5' 0 1 <br />eity of Paris <br />Revised 02119/u9 <br />_ a 000192 <br />