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HomeMy WebLinkAbout2007-09-18 Appointment ~. WL.J Marian Karr From: Anderson, Barrett J [barrett-anderson@uiowa.edu] Wednesday, September 12, 2007 8:11 PM Sent: To: Cc: Marian Karr joseph-maske@uiowa.edu; Peterson, Carole M; Nelson, William R; Volland, Abigail A; Cosby, Alan J; Edler, Crystal E; Grady, David L Subject: New Student Government Appointment Ms. Karr- I am pleased to announce that on Tuesday, September 11th, 2007, the Partnership of the Student Governments of Iowa (PSG I) selected a new Vice-City Council Liaison. His name is Joseph Maske and he is a freshman from West Des Moines, Iowa majoring in Political Science with a Pre-Law designation. He will be an excellent addition to the Student Government Executive Team. We look forward to his contributions and his continuing efforts to keep the lines of communication between the City Council and Student Government open. PSGI is a new creation this year. It comes from the separation of the undergraduate students and the graduate/professional students. The University of Iowa Student Government (UISG) is now the name of the undergraduate student government and the Executive Council of Graduate and Professional Students (ECGPS) is the name for the new graduate/professional student government. Together they form PSGI. This will not change the City Council Liaison's role on the City Council in any way, as the Liaison will still represent all students, both undergraduate and graduate/professional. Please let me know if you would like any further clarification of this new situation. In addition, I would like to clarify the "City Council Liaison Alternate" to "Vice-City Council Liaison" name change. PSGI, after some deliberation, has decided that this new title would be more appropriate in that it better describes the 2-year commitment the position entails. The position itself is unchanged in nature, description, or duties. Please let me know if this title change on our part causes any problems. Thank you. Sarrett Anderson President University of Iowa Student Government 319.335.0900 9/13/2007 r ~~~~ I 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 special 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 electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, September 12, 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 Countyllowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. 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; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007 Application Deadline: Wednesday, 5:00p.m., September 12, 2007 Council Appointment Date: September 18, 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., September 12, 2007 00 Denotes applicant completed the Confidential page of the application. ~ ~ 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, September 12, 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 Michael Tharp, Airport Operations Specialist at 356-5045. 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; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007 Application Deadline: Wednesday, 5:00p.m., September 12, 2007 Council Appointment Date: September 18, 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., September 12, 2007 [R] Denotes applicant completed the Confidential page of the application. r ;-i~~ I NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: HISTORIC PRESERVATION COMMISSION One Vacancy - Three Year Term (1) Summit St District Representative March 29, 2007 - March 29, 2010 Duties of the Historic Preservation Commission include: conducting studies for the identification and designation of Historic Districts; reviewing and acting upon all applications for Certificate of Appropriateness; cooperating with property owners and city agencies regarding remedy of dangerous conditions; furthering the efforts of historic preservation in the City by making recommendations on preservation issues, when appropriate, by encouraging the historical, architectural or cultural value, and by encouraging persons and organizations to become involved in preservation activities. This Commission meets the second Thursday of each month at 5:30 p.m and, if necessary, the fourth Thursday of each month at 5:30 p.m. Iowa City appointed members of the boards and commissions must be eligible electors of the City of Iowa City. Applications must be received by 5:00 p.m., Wednesday, September 12, 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 Historic Preservation Commission should be directed to Sunil Terdalkar, Associate Planner at 356-5243. 7/25/2007 HiSt6tk Preservation Commission Attendance Record 2007 Term Name Expires 2/08 3/08 4/12 5/17 5/31 6/12 6/28 7/12 8/9 Baker 3/29/09 X OlE X X X X X X X Brennan 3/29/08 X X X OlE X OlE 0 X X Carlson 3/29/07 X X -- -- -- .- -- -- -- -- -- -- -- -- -- -- Gunn 3/29/07 X OlE -- -. ---- -- -- -- -- -- -- -- -- -- -- McCormallv 3/29/08 OlE OlE X OlE OlE OlE OlE OlE OlE Michaud 3/29109 X X OlE X X OlE X X X Ponto 3/29/07 X X X X OlE X X X X Swaim 3/29109 X X X OlE X X X X OlE Trimble 3/29/1 0 ---- -- -. X X X X X X X Toomev 3/29/09 X X X X X X X OlE X Weitzel 3/29108 X OlE X X X X X X X Key: X = Present o = Absent OlE = Absent/Excused NM = No Meeting -- -- = Not a Member 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: 5 Females: 4 Council Announcement Date: January 23,2007; March 5, 2007; April 3, 2007; May 1, 2007; June 5, 2007; July 24, 2007 Application Deadline: Wednesday, 5:00 p.m., September 12, 2007 Council Appointment Date: September 18, 2007 HISTORIC PRESERVATION COMMISSION One Vacancy - Three Year Term March 29, 2007 - March 29, 2010 (1) Summit St District Representative Term expires for Michael Gunn William Downing [RJ 411 S Summit St IZI Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee Application Form 1 ~ 1 !~~W~llt ~~T.~ ...... a. CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees 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/Committee Name Historic Preservation Commission Term 3 years Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: ~Age1~21 ~C) r.,_'") >- ::-::: C"- Fl ,r-, --':, f-V NAME William T Downing -<'1 Tl o ~ tiP 522~ lZl Yes DNo '-~ 'J HOME ADDRESS 411 S Summit St Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 29 years OCCUPATION Architect PHONE NUMBER: HOME 358-9949 EMPLOYER Rohrbach Associates PC BUSINESS 338-9311 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I am a resident of a historic conservation district and I have been involved with presonal historic renovation projects for several years. My formal education in architecture included extensive investigation of the history of architecture, culture, and cities. My experience in the profession of architecture has taught me to evaluate existing structures for their historic, economic, functional, and aesthetic value. As member of the business community, serving a diverse group of clients and building users, I understand the need for appropriate design and consideration of many criteria when considering new construction, additions, or demolition. Finally, as a professional, it is my responsibility to give my knowledge and experience to the community to aid others in making decisions about our collective future. I am a member of the local and stat board of the American Insitute of Architects. 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have attended past meetings and I have read and understand the duties of the commission. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I believe that my personal and professional experience can be of use to the commission. I have the educational, business, and personal experience that would be beneficial to discussions about out cities historic buildings and neighbohoods. c5 :: ~~ C~) --::.:...~.. Ii ,.....--..., ',- .' N "' - " i'Oj ,~.) -'. :~ /:,~ -:..- 5> c:> w 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. 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? DYes [{] 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING 1 ~ 1 ~~~:!:Ilt ~~_aD'~ ....... ... CITY OF IOWA CITY Name of City Board/Commission/Committee Historic Preservation Commission Date 09/12/2007 Name William T Downing 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 O~ IV€- :;::.::: :,~~ '-....--' ..l -:::: ("-, (~. ,. ,^ "'1l ". '" ::' ..- f"0 _/ r. . I .'. ,:- - ~:) ::-.:-- .. .......} -:> .. ~ ,-~ <:.,,) NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an addlti~k&Sp Applicant SIgnature ~ ~ Signature of parentlguaraian if Age 15 to 17: Address 411 S Summit St 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 December 2006 Page 3 of 7 r2;~J NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy - Unexpired + Two-Year Term Ending December 31,2009 One (1) person - Age 15 to 17 on the date of filing The mission of the youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. All members of the Commission shall be residents of Iowa City and must be the required age on the date of filing. Said age requirements may be waived by the Council due to a lack of applicants. Meeting time and location to be determined by the Commission. Applications must be received by 5:00 p.m., Wednesday, September 12, 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.icQov.orQ. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041 . x = Present o = Absent OlE = Absent/Excused NM = No meeting = Not a Member KEY: TERM 1/17 2/21 3/21 4/25 5/30 7/18 7/25 8/22 NAME EXP. Audrey 12/31/07 X X X X X X X 0 Keranen Sarah 12/31/07 X X OlE X X X X --- Ziegenhorn Un Weeks 12/31/08 X X X OlE X OlE X X David Segar 12/31/08 X X OlE X X X X X Maison 12/31/07 X OlE X OlE OlE X 0 X Bleam Jacqueline 12/31/07 X X OlE OlE X OlE OlE -- Stubbers Michael 12/31/08 X X X X OlE X X X Nelson (Meeting Date) YOUTH ADVISORY COMMISSION ATTENDANCE RECORD YEAR 2007 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: 2 Council Announcement Date: June 5, 2007; July 24, 2007 Application Deadline: Wednesday, 5:00 p.m., September 12, 2007 Council Appointment Date: September 18, 2007 (Recommendations to be made by Council liaison) *** Said age requirements may be waived by the Council due to a lack of applicants. YOUTH ADVISORY COMMISSION One Vacancy - Unexpired + Two-Year Term Ending December 31,2009 One (1) person - Age 15 to 17 on the date of filing (Sarah Ziegenhorn resigned) Hannah Green [RJ 1204 Sheridan Ave [RJ Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee Application Form I! ! -,....= -~.... !~W~'"!. ""=..,... "'ImJ~II~ ~ - --:!.il.~ ....... ...I.L CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees 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/Committee Name '(D\J-\'\n Adv ~5~r.~ Youth Advisory Commission, Age on the date offiling:fZ1 Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: Term Z ljeo..rS D Age 1?Jo 21 _ r'~''';) C) .~ :2: c) -.r. /""~__J .) n ") lAME \"hnm.~ G reef\ ,~ HOMEADDRESS \L.DL\, Sher,dOJ\ (\\fe.. _. ~ r- rd< ::-C"Jl .__, -;:-=::., =-;'-- ~ \.-.J ~...: ~ZLj () ~ Yei [flo .Is your home address (listed above) within the corporate limits oflowa City? How long have you been a resident of Iowa City? ) ~ ~ eQr<) OCCUPATION 5+vden'1- EMPLOYER PHONE NUMBER: HOME ~ SLt - ~L.\ '5 1 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: o I fI(A\Je h\le~ \'I\L\j\tJ(). ('I"'\-'-\ tr)',-\ '-J J (.);i....V\e \ Ii -.. . , . <.)VI' \\'.:::, K... e C\I n ()\. .2J I n c. E'~ '2 '.:;(-\n \) (j \ .~ . - G?e(~\-,()n S,'h I Ie - r:.e~ (\ 1:1'0 - 'l.e\-reu.-\--\eQYli L-ecle'jer - \-\t>\l.1\ '\2...~\\er.:) (v.Je S;I'lC)d\l(ln~ (Y\C\~S) entIre \\~e G\..V1J hCA.\fe. M j c\ct \.I! -\ es -\-\'\cve ~ n( kde " Misrepresentations an 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? O.~.e C)~ fhe" t-Eucher-S o..el~-ec..\ (\n f +(;, \+1 ':5 ,~) 'yes ",~ an .f\\ l\'1C)\)~\h I (:~().,r~ -\:' y:..,(l\01...~ (Y) 'J &i C.V,::;\.! -':;- ~h\'S '~"" "1 .....)\ ~I . r\ '{'V\ ~3/, r, e (--t<"', t' ("\,\ n\j' + rn (Jv2_ L/"-) v...V '-...C' \ ~. '-..J'- '-.. V'':-'\ ,--" '-' v WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ C. ~(nlr\\Jf\1 coJe \,l.e II . . \1- 0 \. . \ +"- , . V'\J \/oJ, \', L..'-...:::) O,Vla IY\Cj?ee Y'S. J VVl 'Wf\\ \')CC\o.fl,z.ed, 'SrnoJ~\. Q'l\~ fYI0,t0rc, I L_')c::.\~ \'Grwo.rJ. +\:::) -th ~~ - (.\)yvl ~ 35'i ()Vl, \~. \.'J -, \ \ be o..f'l ex c , t-, VI ~ c... h(:::d I e/7,~f' C) _., ~.:::;: (.-, .... "r~_ -::=-- ,.' '- ,..Y. =~ .--. '~-:~ --n ,./- r ... .....' t 'j I :~-:., \ ! . . I 0::::'- ~...../-..., ;~ C',J POTENTIAL CONFLICTS OF INTEREST N 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. (lID-. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ro Yes . D No , DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes r\rNo (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same timer" 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING, I! 1 !~~~~ ~... ~lllIl~ ~:~ CITY OF IOWA CITY Name of City \. J ^ Board/Commission/Committee '\ OU\-'h ,1-\d \J i S\:)0~ C (\vY1\'V1 iSs\'~nDate C~,1 q J 0 -1 Name 'Aonnah G.n?-e VI 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 is attached (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 () /0, I n <", -~-::- '-.. . 03 -' -.- ~~~ '::...:; (- >-. - -, r-;-. I I : .-.-; '.J , ,..,- ~~, ;:-::i )3; \..V NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. APPlicantSignature~ ~~ /~~ Signature of parent/guardian if Age 15 to 17: G- ' ~ C.' h ' Address 11-0'-1 ShendCln Ave. , . . 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 December 2006 Page 3 of 7