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Janice Ellis <br />From: support@civicplus.com <br />Sent: Friday, March 26, 2010 1:50 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online Form Submittal: Application for Boards/Committee/Commission <br />If you are having problems viewing this HTML email, click to view a Text version. <br />Application for Boards/Committee/Commission <br />Tfie Paris CityC;ot+rcli is 900ft axnmitted kdivi+Ws Mvho are 00dicOW ta Ve vwsi-txft Of tte Parls cOmmurdty ta swve on its <br />sta"ng boarft, cxxr► , snd ccxnffiWes. !n . # is 00 QtY COuMiPs po~r ~ , . ~s to a rt~~an of ~o <br />consecutive fiAl"e-yewt+errMS on a given boriy. !n adftw to** Inthe MOcOD't . , O#W <br />quaNficBtions nmy te O~d bY aWtute, CitY Charh9r, 0 ,or' fe"Won. Piess9 oohi~iAs ~kftmuftn ~ belowa►• <br />First Narne* _ ;Vic iL" <br />nddl~SS~ 4020 14,02N,6ok SL <br />y ~wp~ <br />1~si~- . .Pa7J$ ~TX lr~~ ..i 1Wt (A) 7iJMV+6 . . <br />. . . . . . , . . . : t A J ~+7yY~ . . . . . <br />Te3ephone 903-9854427, <br />(909) 123-4561* <br />Areas of IMerest' <br />` [ l AkW AOviorir Boand C l <br />Please note wW specW knowtedge, educaWn, or <br />We'ienoe ya;r haue#stt iS Wgcabte to the fimction <br />of the baard, conwmhWibn, a' +camn~ftee of lnterest <br />(athaO addiiiarM pages if necasswy). aWtc~t►!s, <br />list cates of swtiCe an any City bos►rds, Comtniafofls, <br />or crnnrniitees: <br />. I l Cassevs6s, GommIssion yt I P~e i <br />~(DC~ Ea~ t~nreta~rtend i I 1'ratfie 4 <br />~ ~eg A~±~r ~+~d of <br />~at 8~ Ca~t~xiia~strrn <br />amar' Ctw~y ~3aerd of <br />t~tig & Zot~g Cwntn"on <br />awaWAAAMpi AnAm <br />I wmww <br />GeerddoA`ift-paris'+ ° <br />Ad hetp mAO rne a <br />. ..wa.+wa.,.,~-,.w.,,nNya..w. as.v.,..,.....,«....,.. . . . . <br />Ci8dftatiot1 wO A1V1lzabDt1 <br />1 acknowtecge Ihat ian araare ard agnae to tlh+e prohibi#ons o# Vw City af Paft Chartw &d ft ism o# ft Stao of fiO)w togdirfg <br />nepo#m and'oqnflcb a3 interes# a# appoirrtoes to City baards, taorrimissions, ar►d cWnrIalso, Cer#ity tho #f appobtod f wiit <br />srttend at iead 't5 pe=M of sfl ragular rneet+ngs antt sW rot ham any delkluent MOWln~ ~#w Cky dw' ny Nm+, I <br />understand tto #he r►utnber of poOms on a given board, comtnlsdOn, ar wmmftw ts Nt~iteti anI lfiat ! may rd be appolin#ed; <br />howevsr> if Iah riat appointed, I agree ta be ptaced 'm a deftbam for poseNo ftdm rmtificadan c1 tDpim of interest. icerCfiy that ft <br />inforrr►ation gion by me fn fts Wiicatian is Mie and comcf ani any f81se Wommum ot rrWeprmwtoUan is strffitieM grot+nds fcr <br />disqualfficatilor►. Iauthwdze the CEiy of Paris to verify aff irfatrtatbn provitiet! 9n ltft appkebn. in sowrdance afth Sectior► 552 of the <br />Local GavemmeM C.ode, I understand that infamation provki3ed Mft a3ptica#on may be av2ritadb to tite,pu6Uc upm,request.` <br />[XI A9ree [ l Di5a9tee <br />* indicates required fields. <br />1 <br />149 <br />