10-Appointing Member to the Various Boards

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First Naine: Ben Last Name: Vaughan Address: 1225 SE 20th City: Paris State: TX Zip: 75460 Telephone (903) 123-4567: (903) 785-2759 Areas of Interest: Historic Preservation Coinmission Please note any special knowledge, education, or experience you have that is applicable to the function of the board, commission, or committee of interest (attach additional pages if necessary). If applicable, ]ist dates of service on any City boards, commissions, or committees.: I currently serve on the HPC. Home builder in Paris since 1974 Currently restoring / renovating historic hnmes on Church St MS Educational Psychology; TAMU- Commerce Certification and Authorization 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 conflicts of interest of appointees to City boards, commissions, and coinmittees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and sha11 not have any delinquent indebtedness to the City during my term. 1 understand that the number of positions on a given board, commission, or committee is limited and that I may not be appointed; however, if I am not appointed, I agree to be placed in a database far possible future notification of topics of interest. I certify that the information given by me in this application is true and correet and any false information or misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify all information provided in this application. In accordance with Section 552 of the Local Government Code, I understand that information provided in this application may be available to the public upon request.: Agree Additional Information: Form submitted on: 5/10/2011 10:50:34 AM Submitted from IP Address: 209.86.226.19 Referrer Page: http://www.paristexas.gov/Forms.aspx Form Address: http://www.paristexas aov/forms aspx?FID=69 I ~ti