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DEC. 31. 2C12 i2: 18A�v" ! iB�R?Y BANK FARIS N0. �55 F, 2 <br />BOARD/CO1v�SS�OI�TICO�T'T�� APPL�CATION <br />The Paris City Cotxncil is seeking com.zx►�ttcd 'mdividuals who az�e dedicated to the wcll-bcing o£ the Paris <br />community to serv�c on its standing boards, coz�missions, at�d comx�nittees. I�n general, it is the City <br />Cauncil's poliry to appoint �rsoz�s to a maximum of twa consecutive fitlt thz�eo-yeas t,crms on a gi�ven <br />body_ �n addition� to the genazal qualif cataons listed in the certification b�low, other qualificatians rz�ay be <br />inandated by statute, City Charcer, ordinance, or zesolution, Please wmplete the infon�nation requested <br />below a�d retcim to_ City Clerk, � 50 SE �irst Strcet/�.0. Box 9037, Paris, Texas, 75461. Please note tlaat <br />all qualifed applacanrs will be interviewed in open session by the City Council. <br />Board/ComDnission/Coun�mittc� of Xnterest <br />❑ Airport Adviso�y Boazd ❑ Municipa] Baz�d Comnr►ission <br />❑ Builda�g & Standards Commissaon ❑ Paris.�Lamar County Board of Health <br />�i�vil Sexvice Commission ❑ Planning & Zoning Commissivn <br />❑ Economic Derelo�ment Corporation ❑ Public Library Advisory Board <br />[] Historic preservation Cozz�mission ❑ Traffic Commission <br />[] Housir,g Authority �oard of Coxz�.missioners ❑ Zoning B4ard of Adjushtaent <br />❑ Main Street Advisory Board <br />Candidate Information <br />'WorkPhone: � -%SS- 55�" HorrxePhone: �0�-.27Z-7�9�ca <br />F�: go� - rJ��=3�z9 E-maz� Address: <br />Please note ar►y special know�edge, educatiou, or exp�tier�ce you ha�ve that xs applicable to the functioza o£ <br />the baard, commission, or committee of interest (attach additional pages if nec�ssary)_ If applicable, list <br />dates of service on any City baards, com,missions, or cozaamittees. <br />Certification and .A,utharization <br />By signing balow, i acknowtedga that I aa� aware and agree to the pmhibitions of the City of Paris Charter and the laws of the <br />State of Texas regarding nepotism and conflicts of interest of appointees to Ciry boards, commissions, and oomminees. i also <br />c�fy that if appoirned I will attend at least ?5 percont of all regnlar meed�ngs and shail not have any delinqucnt Indebtedness <br />t� the Chy durtng my term. I understand triai th� numbex of pusitions on a given board, commission, or committee �s limited <br />and ttiat I may not bc eppointed; however, if I am aot appointcd, I agree to be placed in a database for possible future <br />not[f�cation of topics of interest. T certify that the lt�ormation g"rven by nae in this application is true and corroet and any false <br />infor�aiatioxi or misrcpresentation is suf�eiem growads for disquaiificat�e� I suthorizc ttae City of Paris to verify ai] <br />iaformataor� provided in this applicativn. In aecordance witl� Sution 552 of tk�e Local Governn�cnt Cod�, T uaderstand that <br />information provided � 'on may b vailabl� w the pubiic upon request. <br />r <br />Sigz�ature of Candidate: • Da�: ��'�� /�— <br />���c�y e�.xa•� '��rv . , , . . . ., . ; .... ..r _ . . . . . - -; , . <br />C'oaAxet a��ntet;�t: �" / N��aide�gdness:'S."! I�I 1�Y�t►tism: Tt'! I�- D►st.: ��_Z 3� S� 71 prev,+vus.Sct�ae+��,01 �Z 3 d�..._..,�_.y <br />City of Paris Revised 03/08/12 <br />