10-Appointing Member to the Various Boards

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~~At,e-u/Ir;t AYYl,1CA"1'IOl!' The Paris City Council is seeking committed individuals who are dedicated to the well-being of t11e Paris community to serve on its standing boards, commissions, and committees. In general, it is the City Council's policy to appoint percons to a maximum of two consecutive full three-year ternls on a given body. In addition to the genera] qualifications listed in the certification below, other qualifications niay be inaildated by statute, City Charter, ordirlance, or resolution. Please complete the information requested below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas 75461. Board/Commission/Committee of Interest ❑ Airport Advisory Board ❑ Municipal Band Commission ❑ Building & Standards Commission ❑ Paris/Lamar County Board of Health ❑ Civil Service Commission ❑ Planning & Zoning Commission ❑ Economic Development Corporation ❑ Public Library Advisory Board ❑ Historic Preservation Commission ❑ Traffic Commission ❑ Housing Authority Board of Commissioners ❑ Zoning Board of Adjustment EI'Main Street Advisory Board Candidate Information Name: Address: t-60 Z~"~ r1'~~~ ~ • Work Phone: Home Phone:_,.t(IY1Pi Fax: M031 3~~ 014P E-mail.Address: Please note any special knowledge, education, or experience you have that is applicable to the nction of the board, commission, or committee of interest (attach additional pages if necessary). If applicable, list Certification and Authorization By signing below, I acknowledge that 1 am aware and agree to the prohibitions of the City of Paris Charter and the laws of the State of Texas regarding nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness to the City during nry term. I understand that the number of positions on a given board, commission, or committee is limited and that 1 may not be appointed; however, if 1 am not appointed, ] agree to be placed in a database for possible future notification of topics of interest. I certify that the information given by me in this application is true and cotrect and any false inforniation or misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify all information provided in this applicatio . In accordance with Section 552 of the Local Govemment Code, 1 understand that information provided in this able tothe piablic upon request. Signature of Candidate: V"il Date: Conflict of Interest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: 1 2 3 4 5 6 7 Previous Service: 0 l 2 3 4 5 6 City of Paris Revised 08/19/08 100 dates of service on any City boards, commissions, or commrttees.