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Janice Ellis <br />From: support@civicplus.com <br />Sent: Wednesday, May 11, 2011 3:22 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 />The Paris <br />starxgrrg t <br />quatificaticsns rnaY be mandated b <br />First Name" <br />AddtBSS* <br />City"` <br />Telephane <br />(903)123-45fr7' <br />Areas of InWreat" <br />~ Last PENDLETON <br />* <br />475 SE 34 sE <br />Pwis SOW TX Zip* {Xj 75460 <br />()75462 <br />f ~ 7WI <br />9037845832 <br />(I Arpor# Advisory BeWd <br />'Berd omro <br />& Stantlaccls <br />[ ] <br />E l ~ W.ar~r ~s►~r ~rc! s~f <br />~ <br />[ ] Grv# 3ervice Gcammission <br />~nni~ 4Z)OVIiAg C <br />[ ] Em►omk C3evelaprrerit <br />~l Pctblic LbWy y Board <br />' <br />Corp;prako <br />( l Traft eomn <br />EXI HgtMt "an CaMMIsSion I 7ZWft BoWd of tmarrt <br />[X] Hbuft Auirrwity Soeyd af <br />Cotntrtissioners <br />t I Stresf Advisory Baard <br />Piease nots any specia! Irnowledgs, education, cH' <br />experisnce you have ftt is appficable ta the functian <br />of the board, commission, or cammittee of ktterest <br />(attach adtbanal pages if necessary). If applicable, <br />list dates of service on any Ci#y boards, c:omrnissicans, <br />or committees. <br />Certification and Au#hodaation <br />I acknowledge that i am aware and agree to fhe prohibitions of the Gity of Paris Gharter and itte laws of the State of Texas regardirug <br />nepatism arki eonflicts of interest of appaintses to Cityr boarcis, commissions, and committees. t'afsc> ceFtify that if appointed t vaN1 <br />attend at least 75 percent of ali regular meetings and shall not have arty delirnquent indebfedness to tFna CI#y dtrirrg nty tertn. 1 <br />understand that the number of positicros on a given board, commission, or comrrittee is limitec# antf tltat l may rio# be appolrtW` <br />however, if [ am not appointed, I agree to be placed in a database far qossibie fiAure notification of tapics of ` certiiy that the <br />information given by rns in this applicatien is true and eorrect and any false infafrriation or misrepresentation is sufficient grounds for <br />disqua{ificatlon. I authorize the City of Paris ta verffy aN iniormation provided in this aWicat'ron. In accordance with Secfion 552 of the <br />Local Govemment Code, t understand that inforrnation provided in this appkication may be avaitable to the pubffc upon request,"" <br />(X] Agree <br />' indicates required fields. <br />[ ] Disagree <br />The following form was submitted via your website: Application for Boards / Committee / Commission <br />i <br />202 <br />