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MAY-5-2089 10:49A FROM: <br />05/05/2009 11:42 9937841798 <br />T0:9037841798 P.1 <br />CITY OF PARIS rAUt <br />BOARD/COmNIISSIONfCOMMI"TTEE APPLICA'£I41V <br />The Paris City Council is sceking commlitted individuals who are dedicateti to the we]1 being of the Paa'is <br />cvmmwiity to serve on its standing boards, commissiom, taid cotnmittccs. Iu gcneral, it is the Clty <br />Covocil's policy to appoint persons to a m3ximuul o£ two cOnseCUtive fill tbPe*-yBai teTms an agivea <br />body. In addition to tbe gmmal quati$cations listcd in the certification below, ather q-tialificat;Ans may be <br />mandatod by statute, City Cbazter, ordinancc, or tesolution. Please complete tb.e infvrmation requestcd <br />batow and rekum to: City Clerk, 154 SE F"vrst Strect/P.f.l. Rnx 9037, Pe63. Texss, 75461. <br />BeardlCommissionlCommittee of Interest <br />Q Airport Advisoxy Board <br />❑ Building & Sttsududs Commission <br />Civil Service Commission <br />❑ Economic Development Corporation <br />~ Iiistoric Prescrvntian Commisaion <br />Housi.ng At►thority Boaa'd of Commissioncrs <br />❑ Main Street Advisory Board <br />Csndida4p TnfermalYnri <br />❑ Municipal Band Comtmssian <br />❑ psrig/Lamar Cowtty Board af Health <br />❑ Plaruiing & Zoning Commissian <br />Public Library Advisrny Board <br />TxAfric Commission <br />Zoning soara of Adjustmea,t <br />Faesse note aziy speeial knowledge, education, or experiencc you bave that is applicablE to the funotion of <br />tJae board, comauission, or conmnittee of irterest (attach additianal pages if necessaty)• If applioablo, li.st <br />dates of scrvicc on any City boarde, oammissions, or committces. <br />CertificatioD wd Authorizsdon <br />By sigauDg befow, I aclmowltdgt tbat I am awarc and agree to tha pmhibitiams of the City of Paris C}aarcer and the lswe of dw <br />Statc of Tcxss rsgarding aepoti.sm and coaflicts of Werest of appoimecs to City bowds, onmmiesionu, afld eommitbees• 1 ako <br />cer* tLat if appointed I will attcnd ae lcast 73 percent of all re&ular mestiaRs ss►d shall not tuVc aaiy delFnqocnt iwdobtodwse <br />ta the City durirg my term, I understaad that the number of posibons oa a givw baard, commission, or committee is iimfted <br />and thnt T tnay not bc appointed: howavw, it Y am not sppointed, I agree to be placed in a database far Possible fuAue <br />notificaaou af topics of inie.rest I ceitify that tbe infortnation givcn by me in tbis applicatian is t'ue and corrxt and imy tatse <br />iafbrmation or misreprases+tation ie suffiacnt gr+otinds for disqualificadon I euthorize the City of Paris to verifj+ a11 <br />u0oraaation providod in tbia appliontion. 7a ecoozdanca wirh Swtkn 312 af It,e Tncal CsovcrumGUt Codo. t undar'staad tbat <br />information provided in th' ~aauon y bo available bo the public upon rzquest. <br />Sigilaturc o£ <br />17ate,_Q4~n _ <br />Cocfflet of Iiattrrrt: Y / N lndebtedn~w: Y/N Nepotism: Y! N x1i$L: 12 3 4 5 67 Previooro Sewioe: 0 12 3 4 S 5 <br />City a! PAris <br />Rcvtmai 0?11910e <br />w U0G12Worlc Pbone: q'~- Hame Phone: ~I/0 - ~ <br />Fax: qn - 2 o2 E-mailAaaress:_ ay<<i',i-4.. <br />