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BOARD/COMMISSION/COIVIMITTEE APPLICATION <br />The Paris City Council is seeking committed individuals who are dedicated to tlle well-being of the Paris <br />community to serve on its standing boards, commissions, and committees. In general, it is the City <br />Council's policy to appoint persons to a maximum of two consecutive full three-year terms on a given <br />body. In addition to the general qualifications listed in the certification below, other qualifications may be <br />mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested <br />below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas, 75461. <br />Board/Commission/Committee of lnterest <br />❑ Aitport Advisory Board <br />❑ Building & Standards Commission <br />❑ Civil Service Commission <br />❑ Economic Development Corporation <br />❑ Historic Preservation Commission <br />❑ Housing Authority Board of Commissioners <br />❑ Main Street Advisory Board <br />Candidate Information <br />❑ Municipa] Band Commission <br />❑ Paris/Lamar County Board of Health <br />~ Planning & Zoning Commission <br />❑ Public Library Advisory Board <br />❑ Traffic Commission <br />Zoning Board of Adjustment <br />Name: <br />Address: X//I7 Z6"CG_s_,t C 71- <br />Work Phone: 7C% Home Phone: 2 C~ 7 fS5~~/ 3 <br />Fax: E-mail Address: <br />Please note any special knowledge, education, or experience you have that is applicable to the function of <br />the board, commission, or committee of interest (attach additional pages if necessary). If applicable, list <br />dates of service on any City boards, commissions, or committees. <br />Certification and Authorization <br />By signing below, 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 committees. I also <br />certify that if appointed 1 will attend at Ieast 75 percent of all regular meetings and shall not have any delinquent indebtedness <br />to the City during my tenn. I understand that the number of positions on a given board, conunission, or committee is limited <br />aiid that I may not be appointed; however, if ] am not appointed, I agree to be placed in a database for possible future <br />notification of topics of interest. I certify tliat the inforniation given by me in this application is true and correct and any false <br />information or misrepresentat' ~ sufficient grounds for disqualification. 1 authorize the City of Paris to verify all <br />information provided in this applicat' n. In accordance with Section 552 of the Local Government Code, I understand that <br />information provided in this a licat' ay be available to tb <br />y@-1*$c upon reyWst., <br />Signature of Candidate: <br />Date:_Z <br />Conflict of Interest: Y i N Indebtedness: Y` N Nepotism: Y i N Dist.: 1 2 3 4 5 6 7 Previous Serrice: 0 1 2 3 4 5 h <br />City of Paris <br />MAY 12 2011 <br />Revised 02/19/08 <br />_ ~ n R <br />