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BOARD/COMMISSION/COMMITTEE APPLICATION <br />The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris <br />community to serve on its standing boards, commissions, and committees. In general, it is the City <br />Council's policy to appoint persons to a maximum of two consecutive full three-year terms on a given <br />body. In addition to the general qualifications listed in the certification below, other qualifications may be <br />mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested <br />below and return to: City Clerk, 150 SE First Street/P.O. Box 9037, Paris, Texas, 75461. Please note that <br />all qualified applicants will be interviewed in open session by the City Council. <br />r <br />`_.5�:,-i ix! i� t; ir : y`�� <br />Board/Commission/Committee of Interest <br />❑ Airport Advisory Board <br />❑ Building & Standards Commission <br />❑ Civil Service Commission <br />� Economic Development Corporation <br />❑ Historic Preservation Commission <br />❑ Housing Authority Board of Commissioners <br />❑ Main Street Advisory Board <br />❑ Municipal Band Commission <br />❑ Paris/Lamar County Board of Health <br />❑ Planning & Zoning Commission <br />❑ Public Library Advisory Board <br />❑ Traffic Commission <br />❑ Zoning Board of Adjustment <br />Candidate Information <br />Name: 1� 2. c�,— 3 C_.� ��� o�� <br />Address: d2oSd S/ �✓c���� �r►ve,, 1� qr�s %X 7S`/�o2 <br />Work Phone: 40.3 - 78S - 8y8/ Home Phone: 4n 3 %8 /- 8'SOO , <br />Fax: E-mail Address: r�C� ��Or�. L' 4'Mo►��. �O/'� <br />Please note any special knowledge, education, or experience you have that is applicable to the function of <br />the board, commission, or committee of interest (attach additional pages if necessary). If applicable, list <br />dates of service on any City boards, commissions, or committees. . <br />� 1-,c�.v�. eYr�e�tieNC� ��N rev,ew� � a� eor�o�chP�ud�v C�rp01'0.�'e, <br />-��n�nru��a� �N�ormo..�ion� nivdo�v�sinc��l�er��s �'uNdcrs�otid �i��.�Potc.� <br />�i eco roo c�n�e, �i•�eew�4 �✓es -�o � ln.�,s ►nr_c�cs , beca.0 c e ,�� r►-ii� �iNO�vc�a/ <br />`� • a�du.r•�d Z r,a,ve. o��c�� d.. c�. res�rr,�. 1, ,ti,c.lL re�)e�%s rn� work <br />Certi�cation and Authorization <br />eL� p� r� c r� c e.. o.s 0. C e r i��� c�. Pu. �7 / i c� C�uO nJ�la Nd . <br />By signing below, I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the <br />State of Texas regarding nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also <br />certify that if appointed I will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness <br />to the City during my term. 1 understand that the number of positions on a given board, commission, or committee is limited <br />and that 1 may not be appointed; however, if I am not appointed, I agree to be placed in a database for possible future <br />notification of topics of interest. I certify that the information given by me in this application is true and correct and any false <br />information or misrepresentation is sufficient grounds for disqualification. I authorize the City of Paris to verify all <br />information provided in this application. In accordance with Section 552 of the Local Government Code, I understand that <br />information provided in this a�cation may be available to the publie upon-request. <br />Signature of Candidate <br />Date: ��/J� a20/3 <br />Conflict of Interest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: 1 2 3 4 5 6 7 Previous Service: 0 1 2 3 4 5 6 <br />City of Paris Revised 03/08/12 <br />f� <br />