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2012 Main Street Application Page 8 of 30 04/11/2012 <br />MAIN STREET MANAGER INFORMATION <br />❑ Mr. ® Mrs. <br />First Name <br />M. I. <br />Last Name <br />❑ Ms. ❑ <br />CHERI <br />BEDFORD <br />Title <br />Primary Phone <br />MAIN STREET MANAGER <br />(903) 784 - 9293 Ext. <br />U <br />w <br />Secondary Phone (optional) <br />Fax (optional) <br />( ) - Ext. <br />(903) 784 - 1798 Ext. <br />wE <br />-mail address <br />Would you prefer to be contacted by E -mail? <br />Vcbedford(q)_paristexas.gov <br />® Yes ❑ No <br />N <br />MAILING ADDRESS <br />Address <br />135 S. E. 1ST STREET <br />City <br />State <br />Zip <br />County <br />PARIS <br />TX <br />75460 <br />LAMAR <br />SIGNATURE <br />The applicant, by and through its agent's signature below (1) certifies that all information provided in <br />connection with this application at any time is true and correct to the best of their knowledge; (2) <br />acknowledges that any misrepresentation or false statement made in connection with this application, <br />— <br />whether intentional or not, will constitute grounds for denial, pursuant to this application and /or <br />Z <br />assessment of monetary administrative penalties. If signed by an agent (including employee) of the <br />0 <br />applicant, the person signing certifies that he or she is authorized to make the preceding certifications on <br />U <br />behalf of the applicant. <br />w <br />N <br />Chief Elected Official (type or print name) <br />Title <br />ARJUMAND HASHMI <br />MAYOR <br />Applicant Signature <br />Date <br />month day year <br />2012 Main Street Application Page 8 of 30 04/11/2012 <br />