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Cityo <br />I' 2012 Application for Ward 1 <br />Sow Louisville <br />COLORADO • SINCE I SIM <br />City Council Appointment <br />#P.LJCATSO'dS DUE TV ME CITY MANAGER'S OFFICE:OTY HALL, 749 MAIN STREET.. <br />BY 4Pra itfotEtazn30,2011. <br />laf ECIVIEMS ARE SCHEDULED FO3 THE EVEPSIM OF C"JEDrSESOLIV, DECEI,2RER7, 2011. <br />You MUST meet the following criteria to serve as a Ward I City Council member: <br />• You must reside in Ward I and have done so for a minimum of 12 months (see <br />attached map) <br />• You must be a registered elector <br />Name of Applicant: <br />Date of Birth: <br />Home Address: <br />(7_102( I95+ <br />1-2-S Lot-FA-26E_ AVE <br />Louisville CO 80027 <br />Home Phone Number: Cell Phone Number. 3O3 21"1- • I D 23 <br />Email Address: MAJ. Ile-94 !Ufa C0+'InGasf. /✓fit' <br />Occupation: Zan II-E -0 <br />Employer: <br />Length of Time Living in Louisville: <br />Education: r55 QU LIGTIOn!! A, $A <br />STATEMENT OF INTEREST: <br />Please attach a letter or statement briefly describing your interest in serving on the City <br />Council. Feel free to indicate any areas of expertise, background, concerns and /or general <br />information that may be applicable. You may also attach a resume or other information you feel <br />may be relevant to your application. <br />CURRENTLY SERVING ON A BOARD: <br />Do you currently sit on a City Board or Commission? 0 YES cia NO <br />If Yes, please identify that board. <br />It is the policy of the City Council to make appointments t� the City Council, citizen boards, <br />commissions, committees, and task forces based on the needs of the City as well as the interests <br />and qualifications of each applicant without discrimination based on race, color, national origin or <br />ancestry, gender, religious convictions, disability, age, or sexual orientation. <br />18 <br />