10-Appointing Member to the Various Boards

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BOARD/COM117ISSI0N/CQ1VI1`vII1r'TEE APPLICAdTIO1V T'he Pans City Council is seeking committed individuals who are dedicated to the well-being of the Paris cominunity to serve on its standing boards, comrnissions, and cammittees. In general, it is the City Counci]'s policy to appoint persons to a maximum of two consecutive fu11 three-year terms on a given body. In addition to the general qualifications listed in the certification below, other qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please complete the infon-nation requested below and return to: City Clerk, 150 SE First Street'P.O. Box 9037, Paris, Texas, 75461. Board/Commission/Committee of lnterest ❑ Airport Advisory Board ❑ Building & Standards Commission ❑ Civil Service Coinmission ~ Economic Development Corporation ❑ Historic Preservation Commission ❑ Housing Authority Board of Commissioners ❑ Main Street Advisory Board Candidate Information Name: A 44 Address: 4 ig/ c-6C1A_1 c3- Work Phone: f O 3 2 ~~e Phone: ` U,~ • ~ ~ Fax: ~7~~-~ E-mail Address: Cc l/41 6j~ ji r /,0 el.", (S,Qf El C~- 67 Please note any spe.cial knowledge; education,-or experience you h-ave that is applieable fio fihe function of the board, commission, or coinmittee of anterest (attach additional ipages if necessary). If applicable, list dates of service on any City boards; commissions, or committees. ~-~l/~1 G~~C.I~ ~ i✓I ~1 ~O/~i~lG~/9~ ~-~1 ~~l -~.1,%/P1~J ° i'yl~~I'. ~/C' ✓C. -51~4 bl'1r ,0rl q i~UJ .,rr/'.~~c~ YI b.-► co. ~J ~ ' r~'~ `r ~ 40` Certification and Authorization 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 State of Texas regarding nepotism and conflrcLs of interest of appointees to City boards, commissions, and committees. I also certify that if appointed I will attend at least 75 percent of al] regular meetings and shall not have any delinquent indebtedness to the City during my term. I understand that the number of positions on a given board, conunission, or committee is limited and that 1 may not be appointed; however, if I am not appointed, 1 agree to be placed in a database for possible future notification of topics of interest. I certify that the inforniation given by me in this application is true and correct and any false inforniation or misrepresentation is sufficient grounds for disqualification. 1 authorize the City of Paris to verify all information provided in tliis application. ln accordance with Section 552 of the Local Government Code, 1 understand that infonnation provided in tlus appli~ipy~ma,y~vailotpqto the public upon request. Date: Conilict of Interest: Y/ N Indebtedness: Y;' N Nepodsm: Y/ N Dist.: 1 2 3 4 5 6 7 Previous Service: 0 1 2 3 4 5 6 City of Paris Revised 02/19/08 ❑ Municipal Band Commission ❑ Paris/Lamar County Board of Health ❑ Planning & Zoning Coininission ❑ Public Library Advisory Board ❑ Traffic Coininission ❑ Zoning Board of Adjustment E~~IVE. ~ JUN ~ ' r`~~ ~ 96