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First Name: Dustin <br />Last Name: Lindsey <br />Address: 520 24th NE <br />City: Paris <br />State: TX <br />Zip: 75460 <br />Telephone <br />(903) 123-4567: (903) 5 ] 7-8409 <br />Areas of Interest: Street Advisory Board <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.: Currently involved with Design committee for Main <br />Street and have attended several Main Street Advisory Committee meetings. I have enjoyed the work and <br />positive feed back from others with what has been done thus far. <br />Certification and Authorization <br />I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the <br />State of Texas regarding nepotism and conflicts of interest of appointees to City boards, commissions, and <br />committees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and shall not <br />have any delinquent indebtedness to the City during my term. I understand that the number of positions on a <br />given board, commission, or committee is limited and that I may not be appointed; however, if I am not <br />appointed, I agree to be placed in a database for possible future notification of topics of interest. I certify that <br />the information given by me in this application is true and correct and any false information or <br />misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify all information <br />provided in this application. In accordance with Section 552 of the Local Government Code, I understand that <br />information provided in this application may be available to the public upon request.: Agree <br />Additional Information: <br />Form submitted on: 11/17/2010 12:41:18 PM <br />Submitted from IP Address: 66.76.8.42 <br />Referrer Page: http://www.paristexas.gov/Forms.aspx <br />Form Address: http://www.paristexas.qov/forms.aspx?FID=69 <br />142 <br />