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Denene Taylor <br />From: support@civicplus.com <br />Sent: Wednesday, November 17, 2010 12:41 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. RECEIVED <br />App(icatian for Boards/Committee/Commission <br />°i ITY MANAGER. <br />P.ARIS, TEXAS <br />•;E~';~' ~~~f~~ <br />The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to serve on its <br />standing boards, commissions, and committees. In general, it is the City Council's policy to appoint persons to a maximum of two <br />consecutive full three-year terms on a given body. In addition to the general qualifications listed in the certification below, other <br />qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested beiow. <br />First Name' Dustin Last Lindsey <br />Name' <br />Address" 520 24th NE <br />City' Paris State" TX Zip" (X) 75460 75462 <br />75461 <br />Telephone (903) 517-8409 <br />(903)123-4567' <br />Areas of Interest <br />[ ] Airport Advisory Board <br />[ ] Building & Standards Commission <br />[ ] Civil Service Commission <br />[ ] Economic Development <br />Corporation <br />[ ] Historic Preservation Commission <br />[ ] Housing Authority Board of <br />Commissioners <br />[ ] Municipal Band Commission <br />[ ] Paris/Lamar County Board of <br />Health <br />( ] Planning & Zoning Commission <br />[ ] Public Library Advisory Board <br />[ ] Traffic Commission <br />[ ] Zoning Board of Adjustment <br />Please note any special knowledge, education, or <br />experience you have that is applicabie to the function <br />of the board, commission, or committee of interest <br />(attach additional pages if necessary). If applicable, <br />list dates of service on any City boards, <br />commissions, or committees. <br />Certification and Authorization <br />[X] Street Advisory Board <br />Currently involved with Design committee for Main Street and have attended <br />several Main Street Advisory Committee meetings. I have enjoyed the work <br />and positive feed back from others with what has been done thus far. <br />I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the State of Texas regarding <br />nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed I will <br />attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness to the City during my term. I <br />understand that the number of positions on a given board, commission, or committee is limited and that I may not be appoinfed; <br />however, if I am not appointed, I agree to be placed in a database for possible future notification of topics of interest. I certify that the <br />information given by me in this application is true and correct and any false information or misrepresentation is sufficient grounds for <br />disqualification. I authorize the City of Paris to verify all information provided in this application. In accordance with Section 552 of the <br />Local Government Code, I understand that information provided in this application may be available to the public upon request.' <br />(X] Agree <br />* indicates required fields. <br />[ ] Disagree <br />The following fonn was submitted via your website: Application for Boards/Committee/Commission <br />,141 <br />