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Janice Ellis <br />From: support@civicplus.com <br />Sent: Sunday, May 22, 2011 3:50 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online Form Submittai: Application for Boards / Committee / Commission <br />If you are having problems viewing this HTML email, click to view a Text version. <br />Application for Boards / Committee / Commission <br />Eirst Name"` <br />Kenrt~th l.~~t~ M~Is~ap ~P~V~ ~ <br />F ~ ~ ~ <br />AcftUess" <br />310 ~,;Hic~+Qr1t ~3t"ee;~` <br />. <br />. . <br />City <br />* <br />Z~p* <br />TX <br />Pa~S ,StB~e~' <br /> <br />7546~1 <br />Telephone ~ <br />(963)7846063 <br />(903)` 1234564# <br />Airpart Advisory Boatd <br />[ j MurniMi ~and,C~a~~ar~s~c~n <br />` <br />Areas of Inter~'st" <br />`Bui[ding`& Standards CoMrtaissivn' <br />[ ] . "f aiisiR'.~mar Cat~n~y Bt~ard ~fr - <br />. <br />` <br />~ ~ Civa Se~r~ce Cor~mfss,on <br />[X~ ~~nomic pevw opm~rSt ` <br /> <br />~~S&ltln <br />, <br />Atl <br /> <br />~ <br />~qt'~or,t~1 <br />Fri~ <br />~ <br />Y <br />~rd~► <br />~ <br />. <br />Hiitoric Prasenrabcrr► CQmmfsaton <br />~ <br />C~ <br />' <br />Hrwsin Au ~3oarcl. of <br />[ l <br /> <br />~ ~orr~h~ aE~pard o~ A~justrr►+~r~ ~ <br /> <br />~ <br />Cc>trimission~trs <br />, <br />p(l Street Advisory Board <br />Please nate ar+y special kncwy#edge, education, or ' <br />~ Presiden#lQ4arter of J&L Paving, LLC <br />iPFlcabl~; tott~e; ~ <br />experience y8whavb'thaf i~ <br />, <br />functian af ~ard,;~omrrusron, o~ wmmi~ cf <br />h <br />addrtional R499s if ~;cess~ryj: lf <br />ir~teres# 4atta <br />applicable, t,s~ t~te~ a#' s~t~ tir~ a'~ Ci#y boatds; <br />coriimissions;.~-cor~i~n~~est~ = <br />Certification 4iid Au#tioriiation <br />I acknowledge fbat l ar't :aware and agree to'the proliibitinns:of fhe City o# Feris Chaftr arui the {aars cs~t~~ St~te o# Te~as i~4Fdtng <br />o <br />416 <br />7e~e~t.Arrirffi4w't'~Gfc-~.ZfCA'~if"'~T41~1~'~44l1t1ft~fa}R[~~44tY~I• disquatification i auitiorize the CttjreQ#' Aans fo.ve*,all informat~n,provid8d., in this apptication~ fn,a!.cordaraGe ~V~t~.:s~+ctn ~Z a~ the <br />Local Goverriittent Code; I understanc! that infoanafion provit~d in thi "s appEicatan %nay be avaifabte tcci ~ pub~c iipwn r~iqiiest.", <br />tXj Agree [ J Disagree <br />* indicates required fields. <br />The following form was submitted via your website: Application for Boards / Committee / Commission <br />1~~ <br />