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Janice Ellis <br />From: support@civicplus.com <br />Sent: Tuesday, May 10, 2011 8:22 AM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online Form Submittal: Apptication 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 />The Paris City Council is seeking committed individuals who are dedicated to the weN-beitg of the Paris community to serve on its <br />standing boa►cis, commissions, and committees. in general, it is the City CounciYs policy M appoint persons to a maxifnarn of two <br />consecutive tuN three-year tsmrs on a gfven body. In addtUon to the general qualffica#lons listecf in the cerNficatian belpw, other <br />qualiflcabons may be mandated by statute, City Chacter, ordinance, or reedufion. Ptme cofnpleCe the irtFoonnaton requesCed below. <br />First Name' Phillip Last Payne <br />E I~H 1~1„Qmex <br />Address' 575 Laurel tane <br />City' Paris State' TX 2ip" (X) 7S46p 75462 <br />75461 <br />Tetephone 903-737-0531 <br />(903)123-4587' <br />Areas of Interest' <br />Piease note any special knowledge, education, or <br />experience you have that is applicable to the functron <br />of the boarci, com►nissfon, or eommittee of interest <br />(attach additional pages if necessary). If applicable, <br />list dates of service an any City boards, commfssions, <br />or committees. <br />Certification and Authorization <br />[Xj Airport Advisory Boarcf Municipal gand Commissfon <br />[ j Building & 5fandards Pariskamar Courty Board of <br />Commission Heafth <br />[ I Civil Service CommiWan fXI Ptanning & Zoning Gommission <br />[X] Economic Development [X] Pubtic Library Adv+sory Board <br />Corporation [ ] Traffic Gomrnission <br />Historic Preservation Commission I I Zoning Board af Adjustment <br />(Xj Housing Autharity Boafd of <br />Commissioners <br />[ ] Street Advisory Board <br />MS Electrical Engineering, Foter Pitot USAF Served in Turkey, Saudi Arabia, <br />Korea, Japan, Viet Nam, Thailand & Guam. <br />I acknowledge that I am aware and agree to #he prohibitions of the City of Paris ChatEet and the laws of tfle State of Texas regarding <br />nepotism and conftiets af interest of appointees to City boarcJs, commissions, and carnmEttees. l also certify that if appointed t will <br />attend at Ieast 75 percent of a!I regular meetings and shall not have any delinquent indebtedness to the City during my term. 1 <br />understand that the number of positions on a given board, commission, or cammittee is limfted and that i may not be appoinfed; <br />however, if I am not appointed, I agr+ee to be placed in a database for possible future notification o# topics af inferest. I certi#y that the <br />information given by me m this apptication is true and correct and any false infoRnation or rr►isrepresentation is sufficient grounds for <br />disqualification. I authcrriae the City of Paris to verify all informaNon provided [n this appticatian. In aECOrdance with Sectlon 552 af the <br />Local Govemment Code, I understand that information provided in this apptication may be available to the public upon request.' <br />[X] Agree [ ] Disagree <br />' indicates required fields. <br />The following forni was submitted via your website: Application for Boards / Committee / Commission <br /> <br />