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HomeMy WebLinkAbout2010-04-06 Appointment04-06-10 14a 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 Effective Upon Appointment, 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, March 31, 2010. 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 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: 2 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; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, 5:OOp.m., March 31, 2010 ODenotes applicant completed the Confidential page of the application. 14b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy -Five-Year Term January 1, 2009 -December 31, 2013 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, March 31, 2010. 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 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: 2 Females: 0 Council Announcement Date: September 23, 2008; November 3, 2008; December 16, 2008; February 10, 2009; March 10, 2009; April 6, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy -Five-Year Term January 1, 2009 -December 31, 2013 Term expires for Dennis Keitel No applications as of Wednesday, 5:OOp.m., March 31, 2010 ~ Denotes applicant completed the Confidential page of the application. 14c NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-Year 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, March 31, 2010. 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: 1 Females: 1 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; September 18, 2007; November 5, 2007; December 11, 2007; January 29, 2008; March 11, 2008; April 14, 2008; May 13, 2008; June 17, 2008; July 15, 2008; August 26, 2008; October 6, 2008; November 18, 2008; January 6, 2009; February 24, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 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:OOp.m., March 31, 2010 ~ Denotes applicant completed the Confidential page of the application. 14d NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vacancy -Six-yr Term January 1, 2010 -December 31, 2015 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, March 31, 2010. 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: 1 Females: 1 Council Announcement Date: September 15, 2009; November 2, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 AIRPORT ZONING COMMISSION One Vacancy -Six-year Term January 1, 2010 -December 31, 2015 Term expires for Brian Sponcil No applications as of Wednesday, 5:OOp.m., March 31, 2010 O Denotes applicant completed the Confidential page of the application. 14e NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy- Five-Year Term January 1, 2009 -December 31, 2013 One (1) Mechanical Professional 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, March 31, 2010. 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. 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: Council Announcement Date: September 23, 2008; November 3, 2008; December 16, 2008; February 10, 2009; March 10, 2009; April 6, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, S:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 BOARD OF APPEALS One vacancy -Five-Year Term (1) One Mechanical Professional January 1, 2009 -December 31, 2013 Term expires for Tim Fehr (Mechanical Professional) No applications as of Wednesday, 5:OOp.m., March 31, 2010 ~ Denotes applicant completed the Confidential page of the application. U4-U6-7 U 14f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High 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. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p. m., Wednesday, March 31, 2010. 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.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. 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: 2 Females: 2 Council Announcement Date: February 10, 2009; March 24, 2009; May 19, 2009; June 16, 2009; July 28, 2009; September 15, 2009; October 20, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two Year Term January 1, 2009 -December 31, 2010 One (1) person -Tate High No applications as of Wednesday, 5:OOp.m., March 31, 2010 D Denotes applicant completed the Confidential page of the application. 14 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term January 1, 2010 -December 31, 2011 One (1) person -Regina High 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. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, March 31, 2010. 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.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. 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: 2 Females: 2 Council Announcement Date: September 15, 2009; November 2, 2009; December 1, 2009; January 25, 2010; March 2, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 (Recommendations #o be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two-Year Term One (1) person -Regina High January 1, 2010 -December 31, 2011 Term expires for Hannah Green No applications as of Wednesday, 5:OOp.m., March 31, 2010 D Denotes applicant completed the Confidential page of the application. 14h NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy -Unexpired Term Effective Upon Appointment- Ending December 31, 2011 One (1) person - At-Large 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. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high schoo- or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, March 31, 2010. 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 Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. m z~OX ' 3m II II II II II Zz~D~ °Oayv, N ~ ~D ~ ~ ~ 'r ~ '= m 3~x cac ~ c ~ C N ~D A fl- 0 3 ~ < ~ < ~ < ~. ~ v Z 3 m N W ~ N W ~ N W ~ N W ~ N W ~ N W ~ N W .~ ~ m m ~ ~ 3 z 3 z 3 z 3 z 3 c i i i X X X X N N O C ~ _ "{ D m v 3 ~zv< m ~ N ~ ~ m 0 o m O ~3 vN 0 z 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: 2 Females: 2 Council Announcement Date: February 16, 2010 Application Deadline: Wednesday, 5:OOp.m., March 31, 2010 Council Appointment Date: April 6, 2010 (Recommendations to be made by Council liaison) YOUTH ADVISORY COMMISSION One Vacancy -Two Year Term Unexpired term, effective upon appointment -December 31, 2011 One (1) person - At Large (Arianna Aron resigned) Jerry Gao ~ 29 Coll Court D Denotes applicant completed the Confidential page of the application. City of Iowa City _ ~ r 1 Adviso Board/Commission/Committee ~~~,,~~'~~ ~'"~-itrrr~~'~ " pplication Form -~-~- 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. a'te` Advisory Board/Commission/Committee Name ~'~~ '}~`"~~ ~ ~` ~'~'S' a~ Term ~ Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Tvw~ G~ W~~ It.`gl,. Signature of parent/guardian: ` ~ n~4ME ~~- HOME ADDRESS Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? ~ ~ear5 OCCUPATION PHONE NUMBER: HOME ~3~y) 46b ~-9~E1. ZIP ~Z~~ Yes ~ No EMPLOYER ~2~ ~`~-~` S~ t BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: N ~-~d.~,.,-F 5~,~-fie, C.i~oc~- ~,--~-h-~~ ~~ rn ~'=:~ w ~, ~~ Misrepresentations on this application will constitute just cause far removal of an appoir~tee. If you fail to answer all the questions, Council may not consider your application. General Application January 2010 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? (,~ h M ~~,s.; din was es-fu,~o ~t S la,~ ~ -flc, G-C.i f~ l u~ c.. wc,,.~ .~ r,~4~ M ,l 7~- -~ voice -~~r a ~~~..s (~,..d w~~.e,rws, r a,.d r..~-# cis ~e~5~.~-f~~,.vts uk -f~+a. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO -THIS ADVISORY BOARD (OR S1Ai i/ REASON FOR APPLYING)? ende~9 a. ~ ~,~.-P~,~ a . ~ f cam. I -I~.-~ 1 C~.~, w~--~; ~ -~ i~,.-~; 6,.--1~ . ~ --~ co ~r»;~s~ o.. ws I d~9 ba,~v~f -~ ~~ .~, ~~ POTENTCON LI...~ F INTEREST Please id y a~ p` ial conflicts between membership on the advisory board and your personal interests,i . udingiarfg~interests and your duties to an employer. ~_ ~° ,. particular, if you ~ 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 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 ofSection 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 ~ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~ Yes m 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 January 2010 Page2of7 s7~ ~ ~~ 1 ~~~~+® BOARD, COMMISSION AND COMMITTEES ~,, ~~~ BUSINESS LISTING ••n.a~ CITY OF IOWA CITY Name of City ~~~~ ~~ ~ ~ N•:ss~~,,. 2-ZI _ la Board/Commission/Committee Date Name ~Pn r Section 362.5 of the Code of-Iowa generally prohibits, with certain important exceptions, 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). List-all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory`Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS 1'1~n¢. © ° T t"3" a iV °~ ~ , ~ _ ~. ~~ .~+ c~ .C'" U.~ NOTE: A r-ew form must be completed if the above information changes or an ownership interestis acquired in an additional business. A Applicant Signature Signature of parent/guardian (iYoutf'~ Advisory Commission only): Address ~ ELI ~~~ ~- 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 January 2010 Page 3 of 7