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<br />e <br /> <br />e <br /> <br />f" <br />\( <br /> <br />CITY OF LA. PORTE <br /> <br />APPLICATION FOR CITY BOARDS / COMMISSIONS <br /> <br />NOTE: As an applicant for a City Board or Commission, your name, address and phone <br />number may be available to the press and the public. You have the right to request the <br />exclusion of certain information from press and public access. All other information will <br />remain confidential. You will be contacted before any action is taken on your <br />appointment. Incumbents whose: terms expire are automatically considered for <br />reappoin1ment, upon request. A member who is absent for more than 25 % of called <br />meetings, for other than medical reasons, will be subject to removal by City Council. <br />Final decisions on appointment and reappointment of members of Boards and <br />Commissions rests with the City Council. APPLICANT MUST BE A CITuEN OF <br />THE UNITED STATES; A RESIDENT OF THE CITY OF LA PORTE; AND A <br />QUALIFIED VOTER IN THE CITY OF LA PORTE. MEMBERS OF THE <br />pLANNING AND ZONING COMMISSION MUST ALSO BE RESIDENTS OF <br />ONE OF THE CITY COUNCIL DISTRICTS FROM WHICH THEY ARE <br />APPOINTED. <br /> <br />Name: J eSfe1<- /?. eUr~~ <br /> <br />DATE: .:r.., /?- tP, <br />Phone (H'gJ/...#J.., / {, ,,~ <br />(W) <br /> <br />Please tvoe or DrIDt clearlY <br /> <br />Address: /csfr# e,LL4w ;#J. <br /> <br /> <br />city:LA~~ StatelZip:~ 11~1/ <br /> <br /> <br />Are you a registered voter,.in the La Porte City limits? @ or N <br /> <br /> <br />Did you vote in the last City electi~n?.ty or N <br /> <br />Please indicate your preference bv number. 1-2-3. etc. <br /> <br />ADVISORY BOARDS AND COMMISSIONS <br />=- Airport Advisory Board <br />_ Chapter 172 EmployeeIRetiree Insurance Benefits Committee <br />_ La Porte Health Authority <br />Main Street Advisory Board <br />- <br />Youth Advisory Council <br />- <br /> <br />56 <br />