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BOARD/COMMISSION/COMMITTEE APPLICATION The Paris City Council is seeking corrunitted individuals who are dedicated to the well-being of the Paris community to serve on its standing boards, corrunissions, 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 information requested below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas, 75461. BoardlCommission/Committee of Interest ❑ Airport Advisory Board ❑ Municipal Band Commission ilding & Standards Commission 24U' ❑ Paris/Lamar County Board of Health ❑ Civil Service Commission ❑ Planning & Zoning Comrnission ❑ Economic Development Corporation ❑ Public Library Advisory Board ❑ Historic Preservation Commission ❑ Traffic Commission ❑ Housing Anthority Board of Comm:ssioners ❑ Zoning Board of Adjustment ❑ Main Street Advisory Board Candidate Information Name: 1i 1~ - NeA k` Address: C> ~ Work Phone: Home Phone: Fax: ~l C, -3, _1 S T~ E-mail Address:~ U ~oo- C c, M 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. 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 delinyuent 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 inforniation given by me in this application is trve 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 application. In accordance with Section 552 of the Local Govemment Code, I understand that information provided in this appl'cation may be available the public upon request. Signature of Candidate: ~A/ Date: ( Fnr (`itV CICtk'S USC ODlV Conflict of Interest: Y(~) Indebtedness: Y(~ Nepotism: Y~N Dist.: 12 3 4 567 Previous Service: 06 2 3 4 5 6 City of Paris Revised 02/19/08 'w 000158