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FF:Of1 :J rlcFadden & Assoc
<br />FAX N0. :9037854263 Apr. 16 2010 09:21AM P 1
<br />BOALtD/C4M.MISSION/COMMITTEE AFPLICATION
<br />The Paris Cryity Cc,uncil is seeking coinmitted individuals wiio are dcdicated to the well-being oi' the Paris
<br />cummunity tu serve on its standing boards, cOmn.ussions, and conuiiiLtees. lil general, it is the City
<br />eoui,cil's policy to appoit►t persons to a cnaxirnum of twc.~ cansecujivc iul] t1vee,ycar terms oti agivcn
<br />bud,y. In addition to the general qualifications listed in t,he cecrtification helow, other quali ticatioyiti may be
<br />mandated by stacutc, C.'ity C11A,CtCr, ordinancc, e}r resalution. Y1ease complete the informatioli reqticsied
<br />beluw ayid return to: City Clerk, 150 SE First Street/P.0_ l3ax 9037, Paris, 'fclas 75461.
<br />Buard/Commissinn/Cornmittec of Intcrest
<br />0 AirporG Advitiory Board
<br />❑ Ruilciing & Standards C'omm.issic>n
<br />❑ Civil Service Conimi5sion
<br />❑ Econoniic 17evelopmcn[ C'orporation
<br />❑ H1StorlC PfCSet"VaIiUTl C:OmR]LS51c)n
<br />❑ Housing 1luthority IIoard of Commissioiiers
<br />❑ Main Strcet Advisoay Board
<br />Municipal Baiid Ccmiinissicm
<br />E] Paris/Lamar Cnunty Board u!' i-Teal.th
<br />N Ylanning & %oning C'ommission
<br />❑ Public 1.ibrary Advisory 13oard
<br />~ TraffC CUIIliTli;;tiiOt1
<br />❑ Zonuig Board o(' Adjustment
<br />Candidate Informfition
<br />Namc: t"10Q00f
<br />tlddre5s: 53'S 1„O1 t, d uR~
<br />Work Pl,one: q03' 2 4 b r9~4 Hon,e Phone: 03` ~q~-~-,G
<br />~
<br />1'ax: L-mail Address; an ~ w rnGAdden ,co,v,
<br />Ylcase note any special kyiawledge;, edueaticm, or experienec you liave th.at is applicable ta the function of
<br />thc hc►ard, a7minissioii, or com.mittce of intcrest. (attach additional pages if necessary). li' applicAblc, list
<br />dates of service oii any City boards, commi5sians, or commiltees.
<br />PA,~ ~~~ez) + w1/,L/~~3t-C- -,k~ o,\J '19AFFic 6U,qfnls~- I w040 ~r
<br />I ~J 5>F1lJ,0~ PLA)1~1AIV ~ ZDqtiJ(f f F JdL~X~ , .
<br />Certificatiua and Authorv.ation
<br />Ry signing telow, 1 a.cluluwledge that I am awarc and agree to the prohi6itions of thc City of Paris Chai-ter and the la.ws ol'the
<br />Slate of Tcx3s regarding nepulism and cunflicts of intcrest of flppointees ro City bof►t'ds, cqmmissii>ny, mid eutnmittce5. I also
<br />certify that if appointecl I will attend at least 75 percent of all regulaj, meetings and shall not have any iiclinquent indebtcdness
<br />to the City during my term. 1 understand that the nun,ber of positions on a biven board, cocncnisyion, or wmmittee is liiriiLed
<br />ar►d that t may not hc: appointeci; howcver, if 1 am not appointed, .L agrcc tq be plsced u~ a dalabase for pussible firture
<br />iiotification of topics of intel•est. I cerkify thxt the informdticm given by n,e ui this applieation is tnie and carrect a.nd any f"a15e
<br />inlunnation or iiaisCCpreselltaUOn iv sufficic.-nt grounds ffir disquAlification. l autliorizc the C:ity al" Pa.ris to vcrily aIl
<br />infoc•matiorx providccl in this app icfltion. Tn flecurdance with Scctiou SSZ of the Local Goverriment Code, 1 understand ttrat
<br />inforniation provided in this appatioWnfl,ybc~vailable to the public upou requc.wt.
<br />tiig»ariirc ot' Candidate: 0-` Uate: 'V' Zo/U
<br />Por C;1tV Clerk's jLje_Only
<br />C;crntlict of Intcrest; Y/ N- I ndcbtedness: Y /N Kepo?lism Y 1NI)Ist.: 1 2 3 4.'S 6 7 I?'rcvio.us.Setviee; U 1: 2.3 4 5 6
<br />City of Parir Rcvised 08/19/0$
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