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<br />CITY OF LA PORTE <br /> <br /> <br />APPLICATION FOR CITY BOARDS I COMMISSIONS <br /> <br />NOTE: <br /> <br />As an applicant for a City Board or Commission, your name, address andjphot1JiJ.wnl>ef <br />may be available to the press and the public. You have the right to requ~tluu~xclusi6ri <br />of certain information from press and public RCce$S. All other information will remain <br />confidential. You will be contacted before any action is taken on your appointment <br />Incumbents whose terms expire are automatically considered for reappointment, upon <br />request. A member who is absent for more than 25% of called meetings, for other than <br />medical reasons, will be subject to removal by City Council. Final decisions on <br />appointment and reappointment of members of Boards and Commissions rests with the <br />City Council. APPLICANT MUST BE A CJ'flZEN OF THE UNITED STATES; A <br />RESIDENT OF THE CITY OF LA PORTE; AND A QUALIFIED VOTER IN <br />THE CITY OF LA PORTE. MEMBERS OF THE PLANNING AND ZONING <br />COMMISSION MUST ALSO BE RESIDENTS OF ONE OF THE CITY <br />COUNCIL DISTRICTS FROM WHICH THEY ARE APPOINTED. <br /> <br /> <br />Please type or vrin! clearly <br /> <br />Name: e ook <br />Last <br />Address: (;;30 <br /> <br />City: LA ~P-7e- <br /> <br />/)J Dl2.MAI'\/ <br />First <br />II /3Ti <br /> <br />State/Zip Code: fK <br /> <br />s <br /> <br />DATE: /0 - ~-OO <br />Phone (J:f):Jtd! . '170 - ~ bCb <br />MJ-f)/ - f.{7 (,- 22-10 <br /> <br />MI <br /> <br />77S7( <br />V or <br /> <br />N <br /> <br />Are you a registered voter in the La Porte City limits?: <br />@ or <br /> <br />Did you vote in the last City election?: <br /> <br />N <br /> <br />Please indicate ~our nreferenee bv number. 1-2-3. etc. <br /> <br />ADVISORY BOARDS AND COMMISSIONS <br /> <br />Airport Advisory Board <br />Fire Code Review Committee <br /> <br />DECISION MAKING BOARDS AND COMMISSIONS <br /> <br />Planning and Zoning Commission <br />Zoning Board of Adjustment <br />Civil Service Commission <br /> <br />SEPARATE LEGAL ENl1TIES <br /> <br />La Porte Area Water Authority <br /> <br />\. ) <br />I <br />l\ <br />, <br /> <br />Other <br /> <br />f <br />, <br /> <br /> <br />I the undersigned am interested in serving on one of the above Boards I Commissions as <br /> <br />~.~ <br /> <br />Signature of Applicant <br /> <br />/C;.- 30~ 00 <br />Date <br /> <br />Revised April 1999 <br />