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Home My WebLink About2007-01-09 Appointment ~ NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy - Unexpired + 5-yr Term Ending December 31,2011 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide speciai exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible eiectors of the City of Iowa City. The Board meets at the call of the Chairperson. Appiications must be received by 5:00 p.m., Wednesday, January 3, 2007. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment shouid be directed to Randy Hartwig, Airport Commission Chair at 337-2101. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in-law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 0 Council Announcement Date: June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006; November 14, 2006; December 12, 2006 Application Deadline: Wednesday, 5:00p.m., January 3, 2007 Council Appointment Date: January 9, 2007 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy - Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, 5:00p.m., January 3,2007. 00 Denotes applicant completed the Confidential page of the application. ::cr NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING BOARD: AIRPORT ZONING COMMISSION One vacancy - Six-yr Term January 1,2006 - December 31, 2011 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, January 3, 2007. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Airport Zoning Commission should be directed to Randy Hartwig, Airport Commission Chair at 337-2101. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 4 Females: 0 Council Announcement Date: September 20, 2005; November 1, 2005; December 13, 2005; January 23, 2006; February 28, 2006; March 21, 2006; April 18, 2006; June 13, 2006; August 1, 2006; September 5,2006; September 19, 2006; November 14, 2006; December 12, 2006 Application Deadline: Wednesday, 5:00p.m., January 3,2007 Council Appointment Date: January 9, 2007 AIRPORT ZONING COMMISSION One Vacancy - Six-year Term January 1, 2006 - December 31,2011 Term expires for Mark Anderson No applications as of Wednesday, 5:00p.m., January 3, 2007. [RI Denotes applicant completed the Confidential page of the application. ~ NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy - Five-Year Term January 1,2007 - December 31, 2011 It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, January 3, 2007. The City of Iowa City encourages diversity In the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. NAME Gary Haman Steve Buckman Doug DuCharme Tim Fehr John Roffman Chad Campion AI Gerard KEY X = present o = absent OlE = absenVexcused NM = No meeting _ = not a member TERM EXPIRES 12/31/2007 12/3112006 1213112009 12131/2008 1213112007 12/31/2008 12/31/2010 ~, Jan-06 X X OlE X X X X Feb-06 X X OlE OlE X X X Board of AIlj:lj!lji\!!\ Attendance Record 2006 Mar-OG Apr-06 May-06 Jun.o6 Jul-06 Aug-06 Sep-06 NM NM NM NM NM NM OlE x OlE x x x x Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 6 Females: 0 Council Announcement Date: September 19, 2006; November 14, 2006; December 12,2006 Application Deadline: Wednesday, 5:00 p.m., January 3, 2007 Council Appointment Date: January 9, 2007 BOARD OF APPEALS One vacancy - Five Year Term January 1, 2007 - December 31,2011 Term expires for Stephen Buckman Stephen Buckman [R] 215 Amhurst Street (Currently served Unexpired Term) [R] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM I! ! -,..= -~... ~~W~~ '-' --rr'~ ................. CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the . application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. . ADVISORY BOARD/COMMISSION NAME~t)Al'>O ~ h.:~~! -:- 0 Youth Advisory Commission, Age on the date of filing: Age 15 to 17 (or) TERM: ----=\. o Age 18,!g 21 - C) Q ~ :',:>n ("':=1 Signature of parent/guardian if Age 15 to 17: ":'~..,. ~...- r....., .-, -1" \IAME~~\!MALI HOMEADD~ESS~5 A~~~~ ~~pSl ~ ~"~, ~ i,ll ~~~~.:J --- ~ Yes> D~o Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? -2".1 OCCUPATION~ EMPLOYER I PHONE NUMBER: HOME BUSINESS -'d r~ 'I~qa> EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I (:>.\V\ A. Llcl5IJsI:;i> \tIw.A- ~n6Cl' THAT 'N0fX6 WI~ ~Aff PI'6ICi~~ '0 ee;oLVB (c)pct ISSUE;S OIJ !J~~11'( Pl1QJeor, l "AVe ",-"ev~06 ~~ A~ waL. A"'> ~I\tIAJA1l'I SR)P*)\W) 6'( NfPA t rM 61.0.)(., WOiJL Wlm THl. e.-rng~ TWo S-rA"TC \~ ~1\f\IlI<l~-' 1Z> l2eCDIMMoUlIIO A-PO(lTIIJ4 IBM 2Co3 10 5FMo Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? l UNV~2ST~O T~f '\'V'f{pP':i' OF t"OD~ 1vJp 1l!:X' -m 'Pf:~\1,WJe. -me. INlEtJT Of 7I-Ie. J>e;ncIL Ll~) "1llJ<, I~ j/J Qu€:?ll""" WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I WfM.. il\Cf l-IAl "F />.. t:e5ltitJ~ 6UI Al-~ wE:I><!L -nli: lilt. () F- NJ oUJlV&e- A.JJt) ().o()e(L~'1AIUO IlWPMr oLl 4t:& "'5Af'e.-r'( />.~O ~ 11l1pAC1 Of! ~ pec.l~lllJJ. I rtLl..tJtl ~ VI-lD'f?11WO 1tt-WI fOe.. llA~ ~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code oflowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about S~on 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. 0:5 - =- ~T' F>wA.'U Of N-4"( lo,LlfUct' 0(' fN,~ -~~ .' -,">_.. CJ r1 n -ll 'J L1 ,I-j r"! IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 1ZI Yes cf'~.;;: DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Oi?es 0 No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may.not consider your application. General Application June 2006 Page 2 of 7 12-11-06 11:45am From-Dlsiln & Constru~tion Slrvi~ls Ui 3193352722 7-704 P.002/003 F-330 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ J ~ CITY OF IOWA CITY Name of City B N oardlCornmlsslon ... ,,~ 1 Date .oz.. ,0'" . - 1J::'i.\ "" . . ame ectIOn 362.6 of the Code of IOWI! generally proh' ~it&, with certain Important exceptlons..a rnemberafa city arel or Commission from haVing an interest in , city contract. A copy of Section 362.5 lsattached (see age 6). all businesses In which you or your spooseld . partner, orparenlifspplicantjsAge 15to 17, have n ownership Interest (for example, sole proprlett r, partner, 5% or more of oorponltlon'$lotockl,oIcfmgs). .... Indleate If there.sre nane. . BUSINess NAMl! BUSINESS ADDRESS -, ..- . . r",..)' C:;;l SJ_ 0"' j;: - ; ITl -n r-; " u :~ :) ...." ..-.......,....., " i I ,. ::y; ;' ) ----;::----;.-; ~/' r J> ~ NOTE: A new form mU$t be compl lted if the ve information ehangll$ or an ownership Interestls acquired In an additi~1 business I , . a... /-l~ V--i u_ . Dcant Signature . , . "'ture of pare'J!'QLlsrd an If ~e 15 to 17: dress 21;r : . . . JI Misrepresentations on this applic:e ~on will ClChstltute just Cause for removal of an appointee. If you fall to Bnswer all the questions, Counc n may not nsider your application. eneral Application une 2006 'lase 3 of7 s So p Ust II Pie App Big IvJ G J ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: SENIOR CENTER COMMISSION One Vacancy - Three-Year Term January 1, 2007 - December 31, 2009 The duties of members of the Senior Center Commission are to: 1. Serve in an advisory role to the City Council with regard to needs of the Senior Center. 2. Make recommendations with regard to policies and programs at the Senior Center. 3. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. 4. Encourage full participation by senior citizens in the programs of the Senior Center. 5. Ensure that the Senior Center is effectively integrated into the community and cooperates with organizations with common goals in meeting the needs of senior citizens. 6. Serves in an advocacy role with regard to the needs of senior citizens in Iowa City. iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Senior Center Commission meets the third Tuesday of each month at 3:00 p.m. Applications must be received by 5:00 p.m., Wednesday, January 3, 2007. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Senior Center Commission should be directed to Linda Kopping, Senior Center Coordinator at 356-5225. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 3 Council Announcement Date: September 19, 2006; November 14, 2006; December 12,2006 Application Deadline: Wednesday, 5:00 p.m., January 3,2007 Council Appointment Date: January 9, 2007 SENIOR CENTER COMMISSION One vacancy - Three Year Terms January 1, 2007 - December 31, 2009 Term expires for Josephine Hensch No applications as of Wednesday, 5:00p.m., January 3,2007. 00 Denotes applicant completed the Confidential page of the application. ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: TELECOMMUNICATIONS COMMISSION One Vacancy - Unexpired Term Ending March 13, 2009 The duties of the Telecommunications Commission include serving as a review board to resolve disputes between any subscriber or potential subscriber and the cablevision company; reviewing and auditing reports by the cablevision company to the City as required by the Cable Television Ordinance; working with the public, the media, the City, and the cablevision company for the purpose of making recommendations on various issues; engaging in other activities pursuant to the effective monitoring and evaluation of the CATV system in the City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Telecommunications Commission meets the fourth Monday of each month at 5:30 p.m. Applications must be received by 5:00 p.m., Wednesday, January 3, 2007. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Telecommunications Commission should be directed to Drew Shaffer, Cable Television Administrator at 356-5046. 11/30/2006 TELECOMMUNICATIONS COMMISSION 12 MONTH ATTENDANCE RECORD 01/01/03 to CURRENT Meeting Date Kimberly Saul Melkes Brett Castillo Terry Smith Jim Pusaek Thrower 6/2103 X X X X X 7/28/03 X X X X X 8/25/03 X X X X ole 9/22/03 X X X X ole 10/27/03 X X X X ole 11/24/03 X X ole x x 12/15/03 ole ole X x x 112/04 x ole x x x 1/26/04 x x x x x 2/23/04 x ole x ole x 3/22/04 x x x x x 4/ 26/04 x x x x ole 5/24/04 x x OIC x x 6/28/04 x x x ole x 7/26/04 ole x x x x 8/26/04 did not meet did not meet did not meet did not meel did not meet 9/27/04 X X X X X 10/25/04 X X 11/04 Did not meet Did not meet Did not meet Did not meet Did not meet X X X X X 12/20/04 1/24105 X X X X X 2/28/05 X X X X Gary Hagen 3/8105 X X X X x 3/25/05 X 0 X X X 4/25/05 x ole X X X 5/23/05 X 0 x vaeanev X James X x Bebe x Ehrmann Balantvne 6/27/05 X x X X X x Michael Chrltians 7/25/05 0 X X X X 9/26/05 0 X X 0 X 10/31/05 X X ole X X 11/28/05 X X X X X 1123106 ole X X 0 X 2.27/06 X X X 0 X 3/27/06 ole X X John X Weaterson X 4/24/06 X X X X X 5/22/06 0 x xlo 0 X 6/26/06 0 X Vaeanl 0 X Nick Parker 7124/06 x x x X 8/24/06 X x M. Wietlna olc X 9/25/06 x x x Olc X 10/23106 x X x olc x 10/30106 x x x vacant X 11/27/09 x x x x (X) = Present (0) = Absent (Ole) = Absent/Called (Excused) Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 1 Council Announcement Date: November 28, 2006 Application Deadline: Wednesday, 5:00 p.m., January 3, 2007 Council Appointment Date: January 9, 2007 TELECOMMUNICATIONS COMMISSION One Vacancy - Unexpired Term Ending March 13, 2009 John Weatherson resigned Brett Gordon IZI 224 N Dubuque St IZI Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM I ~ 1 --= -~... ~~W!:'"!. "-.... ...~'~ .....~ CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ICTC TERM: Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) 0 Age 18 to 21 Signature of parent/guardian if Age 15 to 17: NAME Brett Gordon HOME ADDRESS 224 N. Dubuque SI. ZIP 52245 Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes 0 No How long have you been a resident of Iowa City? >45 years OCCUPATION Licensed Massaqe Therapist EMPLOYER Omni Therapies PHONE NUMBER: HOME 337-4545 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITIOt}l;, - = Former Chair CATV-5 West Branch Cable Commission Former V.Chair 18 PATV BOD BA Communications Studies UI Community Producer since 1979 ;;d :':.::(; ;..r;.=: ~ i;: 11 ,'-'- --'-.. ~. ,,' ':':::~ c-", , w ~ !1 ~"._; --<..... )i i 97~ ::>- 5> en Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application November 2005 Page 1 of7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ICTC oversees 7 PEG channels on MediaCom Lineup via a franchise agreement with the City of Iowa City. It has an open seat. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I make Television and believe non-commercial media is an important piece of the public dialog. I wish to serve the public by educating myself on the regulatory aspects and issues concerning local control of our non-commercial media and contribute ideas to the ever changing landscape of telecommunications. "" 0 -.- C:;J - "-,,. r, ~-:--. :-:;;. .~> ---I _.~ -- .....,- II ~) I ~~:::i r-' c..) . ~ :Tl ~-', ;'- -0 c--, 5~2 ~ ',-.) <;:/"- - .. )> (J"l POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. To be clear of all such interests and constraints: upon conformation to ICTC I will resign my 3rd term with 18.PATV. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes D No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application November 2005 Page 2 of7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I! I --= -Q... ~~ai!:"!. -..:::.... .....,~ ...... .. CITY OF IOWA CITY Name of City Board/Commission ICTC Date 01/03/2007 Name Brett Gordon Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Gordon Properties 224 N. Dubuque SI. IC Downey Street Cafe 105 S. Downey St West Branch "" 0 1:..-:;') ~ ";'"J L. --> :-;J;,.'" ,)'< - IJ I ----Ie) w :-.,-, ~:" r--' ,_ C~ -U , ,-'-J "'- - -';;:/'" - .. .>> c.n NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional b~ess. , Applicant Signature ~~~ Signature of parenUguardian if Age 15 to 17: Address 224 N. Dubuque SI. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application November 2005 Page 3 of 7