HomeMy WebLinkAboutWierApplicationToHAPNRECEIVED
City of Port Townsend FEB 2 32009
250 Madison Street, Suite 2
Port Townsend, WA 98368
(360) 379-5083 CITY QF PORT TOWNSI
Fax (360) 385-4290 ADMINISTRATION
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DECLARATION OF INTEREST
I wish to be of service to our Community and request your rnnsideration for appointment
to the _ ~ A-~1J
(Name of.
Force -submit one declaration jor each)
LTAC Applicants Only: Are you representing a lodging establishment (collector)? ~ 0
Are you representing an organization authorized to receive bed
tax funds (recipient)? --~a
Name: C.~ ~ ~ ~c,~
Address: ~o ~ 212
Email Address: r h a ~-aJ ~- 2 e~('S C.tN~^
Phone: 3iL0 ~!(~( c~S6~ (home) ~ liD 3$5 35& i (work)
Employer/Occupation: ~.(,.1~
Are you a resident of the City of Port Townsend?
Are you a registered voter of the City of Port Townse d? yaS
Length of residence in Port Townsend? ~ ~nezz rs ~
What community activities have you~(D'i~articipated in daring the past tfive years?
ll/co arlrn nnovc if naroscnrvl CD ~ ]~,w.e~~~i't'>J G'fo~m leh-Y•ea'S~
Are you serving, or have you served, on any citizen advisory boards, commissions,
committees, task forces? (If yes, list the organizations and dales ojservtce Use extra pages ijnecessary.)
Organization: S u.~n ~ Date(s) of service: ~q 9 - o `~
Organization: G ~ t, . ~ ~~ cur Fu.'f~bate(s) of service) 'o z -'~ 4
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COPIED TO COUNCIL q ~ • S.
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Please provide a brief background sketch including job experience, education, skills,
What problems, issues or concerns do you see facing this particular advisory board, and
how would you propose they be addressed: (Use extra pages of nec~essar~y.)
r i
What special skills, knowledge, or experience do you have to contribute to this particular
advisory board/committee/rnmmission/task force? (Use extra pages~/'necessary.) ~ ,
What limitafions, if any, are placed on the time yon would be available for meetings and
other activities? How much time are you able to devote to the duties of this advisory board,
committee, codmission or task force? ~se extra pages if nece 1ary.) _ _ (• n, ~ n
Please list three residents of Port Townsend yon wish to use as personal references that can
provide us with information pertinent to your application:
Name
Address
r J \S/ ~ U
Telephone
CIS - (2~
Telephone
~~~
Name
To assist us with our communication and marketing efforts, please indicate how you
learned of this vacancy.
Newspaper, please specify:
Utility bill insert
Other, please specify: ~?,,~e,n,n c ~at`~
~ ~ ~~ ~
Signature• ~ ~ i/,
Council Member
City Staff Member
City Web Site
Date• 22~ ,a °I
Please return to City Clerk, 250 Madison Street, Suite 2, Port Townsend, WA 98368
Thank you for your interest io service to our community.
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