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B4ARD/COMMISSYON/COMMITTEE APPLICATION The Paris City Cauncil is seeking committed individuals who are dedicated to the well-being of the Paris community to serve oa its standing boards, cornmissions, and committers. In general, it is the City Council's policy to appoint persons to a maximum af two consccutive full three-year terms on a given body. in addition to the general qualifications listed in the certification below, othec qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please camplete the information requested below and return to: City Clerk, 150 SE Fitst Street/P.O. Box 9037, Paris, Texas, 75461. Bosrd/Commission/Commtttee of Interest ❑ Airport Advisory Board ❑ Building & Standards Commissian ❑ Civil Service Commission ❑ Economic Development Carporation ❑ Historic Preservation Commission ❑ Housing Authority Board of Commissioners ❑ Main Street Advisory Board Candidate Information ❑ Municipal Band Commission ❑ Paris/L.amar County Baard of Health ❑ Planning 8c Zaning Commission Public Library Advisory Board ❑ Traffic Commission ❑ Zoning Hoard of Adjustment Name: D&orah &v-,deYS avt- Address: ~70S;- ()6K L i-~ Work Phone: 4a- Home Pboae: 9a3 -7X's- 5 y~C~ Fax• E-mail Address:d 6Cfrenn (2_ W, g h-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 addidonal pages if necessary). If appIiceble, list dates of service on any City boards, commissions, or c:ommittees. 0Ce V; oj4S Se.vv' i`c~ ~ 4--ke- Lo~ret -T + c h ~ u n~e~ S L°~r~' ~ ~-~.•e~' r ie 5S Certifcatton and Authorizatlon By signing betow, I acknowledge that I am awane and agree to the prohibitions of the City of Paria Charter end the laws of the Statt of'Texas regarding nepotism ead coaftts of iaterest of appointees to City banrrds, commissions, and committees. I aisa certify ibat if sppointcd l wiU attend at lesst 75 peccent of ali ngular meetings and shall not heve aay delinquent indehtedneaa to the City duting my term. 1 understand that tbc numbet of pasidons on a given board, ctrmmission, or committee ia limited and that I may not be appointal; howtvar, if I am not appoiuted, I agree to be placed in a daWbase for possible fudme notification of topics of interest- I certify that the informarian given by me in this applicatioa is mre and cornct and any felse informatian or misrepresentation ie suf5cient grounds Cor disqualification I authorize the City of Paris to verify aif information provided in this apptication. In accordance with Sectioa 552 of the Local Governnunt Code, I understand that infortnadoa provided in this application may bt availabk to the public upon request. Signature of Candidate: Da1e:~.100 For Citty'clern i1sr Aw1v ConQJct of Iuterat: Y;Rindebtednea: Y/4@)Nepotism: Y("st.: 12 3 4 5 6 7 Previons Servtoe: 0 12 45 6 City o! Paris RevbW aV14M M 000169