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Golf Course Advisory Board Application <br />Page 2 of 3 <br />Cityor <br />Louisville <br />COLORADO • SINCE SS/ <br />(,a ,} L C.veel( rs m F-Yrva r e 9 0/F co 1? ys ( 1 +v1 ,j ±per <br />tv +t T /i 7 d toe 1/ . yo e /wee e <br />�p / i w u , q b,fec7 (n1 f 4c? 0/ e s ocCPSS <br />1 <br />goer- Go v v- S A +U D 7 e co/14n, v ,Li <br />1 L 6 v -R //:, 1,v-5 /N u , s v, /60 4 ti 4.171- NT ' <br />A /LeOfa / % e rQ Tt / 4 C C' i 47` ,7` /s <br />NOTE: You may also attach a letter, resume, statement, or other information you feel maybe <br />relevant to your application. <br />CURRENTLY SERVING ON A BOARD: <br />Do you currently sit on a City Board or Commission other than the one for which you are <br />currently applying? ❑ YES It NO If Yes, please identify that board. <br />SCHEDULING CONFLICTS: <br />What times Monday through Thursday are you generally unavailable to attend meetings? (The <br />meeting times of each board are available on the City's web site at www.l.ouisvilleCo.gov.) <br />DISCLOSURES: <br />Within the last ten years, have you ever been convicted of a crime or received a suspended <br />sentence, deferred sentence or deferred prosecution, or forfeited bail, for any offense in <br />criminal or military court, or do you have any criminal charges currently pending against you? <br />Exclude minor traffic violations. ❑ YES • NO If yes, list for each case: <br />(1) date of offense; (2) charge; (3) jurisdiction; (4) court name and (5) disposition: <br />Within the last ten years, has your driver's license in any state ever been suspended or <br />revoked, or have you ever been denied a driver's license in any state? ❑ YES 15 NO <br />If Yes, please explain below: <br />n, v C <br />Have you ever been involved in an incident involving child /elder abuse or child /elder neglect <br />for which a report was filed with or issued by any law enforcement agency or social services <br />agency? ❑ YES it NO If Yes, please explain below: <br />21 <br />