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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 information requested below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas, 75461. Board/Commission/Committee of Interest ❑ Airport Advisory Board ❑ Municipal Band Commission r~Q Building & Standards Commission ❑ Paris/Lamar County Board of Health ❑ Civil Service Commission ❑ Planning & Zoning Commission \`~conomic Development Corporation ❑ Public Library Advisory Board ❑ Historic Preservation Commission ❑ Traffic Commission [X-l Housing Authority Board of Commissioners ❑ Zoning Board of Adjustment ❑ Main Street Advisory Board Candidate lnformation Name• Address: O s i L~ ~ Work Phone: Home Phone: _S~0 3' 7 g~' 0~2.9 Fax: E-mail Address: Y' aoST'Ot-IM S~ ~ t1~E..n1 U n/fC~ dE T' 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. c ;r-s ~ E _ ( Ctr.Ci\U' c- 12-1. ~a CertificaNon 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 1 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 misrepresentati ' is sufficient grounds for disqualification. I authorize the City of Paris to verify all information provided in this a plicatioa In ccor nce with Section 552 of the Local Government Code, I understand that information provided in this ap lic tion y' av 'lable to the public upon request. . Signature of Candidate: ' 0-~--~ Date: 4117 iZQ O FQr Citv Clerk's Use Oql,v - Conflict of Interest: Y/ N Iadebtedness: Y/ N Nepodsm: Y/ N Dist.: 1 2 3 4 5 6 7 Previoas Service: 0 1 2 3 4 5 6 City of Paris Revised 02/19/08 QU,0 15 y