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The following form was submitted via your website: Application for Boards/Committee/Commission <br />First Name: Mary <br />Last Name: Hughes <br />Address: 514 Booker T. Washington Homes <br />City: Paris <br />State: TX <br />Zip: 75460 <br />Telephone (903) 123-4567: (903) 785-6714 <br />Areas of Interest: Housing Authority Board of Commissioners <br />Please note any special knowledge, education, or experience you have that is applicable to the function of the <br />board, commission, or committee of interest (attach additional pages if necessary). If applicable, list dates of <br />service on any City boards, commissions, or committees.: I am a current member of the Board of <br />Commissioners of the Housing Authority of the City of Paris, and wish to remain on the board. <br />Certification and Authorization I acknowledge that I am aware and agree to the prohibitions of the City of Paris <br />Charter and the laws of the State of Texas regarding nepotism and conflicts of interest of appointees to City <br />boards, commissions, and committees. I also certify that if appointed I will attend at least 75 percent of all <br />regular meetings and shall not have any delinquent indebtedness to the City during my term. I understand that <br />the number of positions on a given board, commission, or committee is limited and that I may not be appointed; <br />however, if I am not appointed, I agree to be placed in a database for possible future notification of topics of <br />interest. I certify that the information given by me in this application is true and correct and any false <br />information or misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify <br />all information provided in this application. In accordance with Section 552 of the Local Government Code, I <br />understand that information provided in this application may be available to the public upon request.: Agree <br />Additional Information: <br />Form submitted on: 5/19/2009 2:01:52 PM <br />Submitted from IP Address: 64.218.7.233 <br />Form Address: http://www.paristexas.gov/forms.aspx?FID=69 <br />- (1 ll 0i1 ~ <br />