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Janice Ellis <br />From: support@civicplus.com <br />Sent: Wednesday, April 27, 2011 11:22 AM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online Form Submittal: 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 />Firsfi Natne* <br />Address" <br />City* <br />Telephone; <br />(903)123-4667"` <br />Areas of frftrest" <br />m ' <br />P.O. Btut 2 <br />Pettyt 5tw 'fX. ZIP~ (X) '?'uw 7602, <br />75470 f 1 75461 <br />903-317-4248 <br /> <br />Ptease note any speciat knawledge, educ.atwn, or 1 have ovvnsd a historic bcnlding Ot 123 Clwksuft fcu #►o las# 2 years, trr those 2 <br />experience you hate tha# is aPplicmbte tv the yom, i've been telbre the commMion an boW of my ' % In crder lo rnak,e <br />function ofi the bQard, e,ommission, or cornrn€ttee crf repairs arKt knprove the fagad€s, giving me knowleds of procedtm necessM <br />interest (attaeh addftic)4ei pages if necessYy}. lf to affect the pmserva#ion c►f rny building <br />appticable, list da#es af senriGe on any City boards> <br />commissions, cyr committees. <br />Certification and Authorization <br />I acknowW€fge that i am awaee and agree to the prWbffiens o# the Gity of Paris Charter and the laws af the S#aEs of Texas regatding <br />nepotism and eonfliets of interest of appoifltess to Ci#y toards, commissians, and eommiZtees. F atso certiiy t'rat if appoutted 1 wiM <br />attend at ieW 75 percent of aU regular meetfngs and shalt not have any cletinqusrrt bidebtedness to the City curing rny term. <br />understand that the numtter o# pasitions on a given bosrd, commiWon, or commi#tee is l'irnited antl tltat I may not be appcyirdegt; <br />however, Ff E am not appainted, t agree to be placed fn a database fior passibte future notificabon of tDpic$ of i t codi!'jf #tat ft <br />infcxmatian given by me in this appticaticm is true and reurect and any false information or misrepresenfafion is sufttent groctnds fvr <br />disqualificatfon. I authorize the Ci#y of Parts to verft'y all! irt#ormaati€xn provfded in tltis application. In aceordance vnth Sec#ion 552 of the <br />Local Government Cade, 1 understand that infiormation provided in this apptication may be availabte ta the public 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 />220 <br />