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02-1007COUncilFile# C'Ja1�w�@� Green Sheet # an �.� :� RESOLUTION CITY OF SAINT PAUL, NIINNESOTA Presented By Refened To �� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 REAPPOINTMENTS 16 17 James DiZio Robert Patient 18 Jill Peterson 19 20 The terms of these individuals shall expire on December 31, 2004. 21 22 RESOLVED, that the Saint Paul City Council consents to and approves the appointments and reappointments, made by the Mayor, of the following individual to serve on the NeigLborhood Advisory Committee. APPOINTMENTS Vic Ames Catherine Smith Edlund Gerald Krieger Mark Rindfleisch Lori Spiess Committee: Date Jeff Benning Robert Hannaman Nora McKinnon Nancy Sabin The terms of these individuals shall expire on December 31, 2004. fied by Council Secretary By: Mayor: � � By Requested by Department of: BY: Adopted by Council: Date lVl�9 . L. Ca Q'� _� 01 _ �001 's Office Kurt Schultz 6-8512 October 30, 2002 � TOTAL # OF SIGNATURE PAGES GREEN SHEET nE..nmm� owECroR "� 202321 arvcaun � UIYAiTOPIEY ❑ QIYCtFpK � ❑ w,axc.i.a�aNeESOw. ❑ wlwun�aomucra ��uwrt(ortwsasrwnl ❑ (CLIP ALL LOCATIONS FOR SIGNATURE) Approving the appointment of Vic Ames, Jeff Benning, Catherine Smith Edlund, Robert Hannaman, Gerald Krieger, Nora McKinnon, Mark Rindfleisch, Nancy Sabin, and Lori Spiess to the Neighborhood Advisory Committee. Approving the reappointment of James DiZio,.Robert Patient, and Jill Peterson to the Neighborhood Advisory Coffiittee. or PLANNING COMMISSION CIB COMMITTEE CIVIL SERVICE COMMISSION OPPORTUNI7Y OF TRANSACTION SOURCE Has ihis personffirm ever xrorked under a contract for this departmeM? VES NO Has teis PersoNfirm ever been a taY empbyee9 YES NO Does this perso�rtn po6sess a slall not namalypossessetl by any curreM city emPbyee? VES NO Is this persoNfirm a tarpeted vendo(t YES NO rlain all Ves a�axers on seoaiate sheet and attach to areen sheet COST/REYENUE BUDGEfED (CIRCLE ON� ACTNITY NUMBER YES NO (EXPWN) cZ-�� CI'1`Y �F SAINZ' PA�., 390 Ciry Na11 Telephone: 651-266-8510 RandyC.Ke11y,Mayor ISWestKelloggBoulevard Facsimile:651-266-8513 Saint Pau(, MN 55102 To: Saint Paul Citv Councilmembers Council President Dan Bostrom Councilmember Jay Benanav Councilmember Jerry Blakey Councilmember Chris Coleman Councilmember Patrick Hanis Councilmember Kathy Lanhy Councilmember James Reiter From: Kurt Schultz Assistant to the Mayor Date: October 23. 2002 RE: Neighborhood Advisory Committee Mayor Kelly has recommended the appointment of Vic Ames, Jeff Benning, Catherine Smith Edlund, Robert Hannaman, Gerald Krieger, Nora McKinnon, Mark Rindfleisch, Nancy Sabin, and Lori Spiess to the Neighborhood Advisory Committee. The terms of these individuals shall expire on December 31, 2004. Mayor Kelly has also recommended the reappoinhnent of James DiZio, Robert Patient and Jill Peterson to the Neighborhood Advisory Committee. The terms of these individuals shall expire in December 31, 2004. Attached is a copy of the resolution nominaring these individuals as well as the applicarions for those being appointed. Please remember that certain information on the applications is classified as private and should not be released to the public. Feel free to contact me at 266-8512 if you have any quesrions regarding the appoinhnents and reappoinhnents. � e ./�'�fL.S� �Ti�-'�f� cc: Charlotte Strong, Neighborhood Advisory Committee Staff Person � O�.-��o�j Application for Committee, Board, or Commission Please return to Mark Engebretson Mayor's Office, Room 390 City Hall 15 West Kellog� Blvd., Saint Paul, MN 55102 Phone:651-266-8533 Fax:651-266-8513 The Minnesota Government Data Practices Act (Minneso�a Stacutzs Chapter l3) governs the City's use of [he information contained in this application. Somz of �he information sough� in this application is priva[e data under the Acc. The requested information will be used by the appointing au�hori�y [o carry out the City's official appointmen[ responsibilicies. You are not rzquired co provide any information. Howeveq failure to answer the application questions may cause the appoincing autfiority to reject your application. The majority oE items contained in this application are public, includin� name, address, empioymenq skiils, training and experience, and are therefore available to anyone requestina it. The remainin� items on thz applica[ion form are dassified as privace. The private data is available only to you and to o[her persons in the Ciry who, because of work assfgnmen�s, reasonably require access m the information. Name �/� (.. Homeaddress /.5/5 p �,p �� 55/Ufj svice[ �iry s[a[e vp Telephones `�� _ ��(S �y/� � ��3- ?yy-ssas PleaseindudeAreaCodes home work fax E-mail address �/�t_P.w�� a.{-/C . eo�.-� Planning District Council City Council Ward Preferred mailing address �...., uy aw�c up Occupation fjKS��.e.SS OPNeCo�?wt�w� 2�� Place of employment Employment address y7� nJ �u,,�.(,« L� +3W� Committee(s) applied for What skills/training or experience do you possess for the committee(s) for which you seek appointment? rt�l �w��,e.r c�{'- O i s-l�- i c-t /O r3a�r�( _ page 1 of2 O'�—�oe�� Personal References IvTame �8 .�.�-' �Su-v�2 �/ Address 5�,�,4�., y— ✓�-I�sq•� ►+il.[� Telephones G l2 —�-(7. 3' S�� S' Please inc4ude Area Codes home work aihzr Name (Z V�.v�, E-�.� Sc7 v. Address �DO� bcrr�/ � a✓f/�l Telephones ( �-'( _ 'j 3Qj — �j S 5 � Please include Area Codes homz work other Name �j{-PNe.. j YOJ'�'✓ti�� Address ✓�t.�� rW� Telephones (p� 2 — ��.("j — (p?q Please include Area Codes home work other Reasons for your interest in this particular committee �er SM..e L C w. � J o f �(� S �.�C'�- W'. Have you had previous contact with the committee for which you are making application? If so, when, and under what circumstances? In an attempt to ensure that committee representation reflects the makeup of our community, please check the box applicable to you. This information is strictly voluntary. � White (Caucasian) � Hispanic �Black (African-American) � Asian or Pacific Islander � American Indian or Alaskan Eskimo � Male Female � Date of birth Disabled: � Yes No � If special accommodations are needed, please specify How did you hear about this openin�? page 2 of 2 � /� J �� J �Ll 101 �� ,� b � t 3 /�'/dna 5 j', Street ✓� b '3,_�0 0 � [../ � , ' RECE1�lED .�__._ � ` JAN 2 � 200f MAYOR'S OffICE Nazne: � e�f I�2A/ ,'n J Home Address: Te(ephone: (Hom� Planning District � Preferred Mailing Office of the Mayor 390 City HaII Saint Paul, Minnesofa 55102 266-8525 Fax:266-8513 FS �i 57�. ��•� /H iv � S/o FS City ,, Zip �S!-�= 56G/ ns�,..�� d _ �--s3�(o' �4 �_�__. City Councii What is your occupation? /7�«�� i�f PlaceofEmployment: ��+�; y+��• ` F�.� 0/�%��'e. Committee(s)appliedFor: /7�f{N1c� N ��%�'/ C �""""•'�� What skills/training or experience do you possess for the committee(s) for which you seek appointment? S �a'� o /r y�,r� o-f' �s;.,,�.ss ex/�e:;�.-, �e ,�n cc.�./h�.,.ir,z �nn�,`n.%^� .i+ S:ZZ' 'F%e.s� �n:� �nN/F.`_n..f�-.a.P �.or/Ja�,.,��ci5 �i s,� �i �. 5� - �,c s � , t—�� , .,, o s_ .�- �-�i ,� � �,,d�s;�.,.•e e.dxn'e� c� w;r� � �e P� , r �, d,,,'s.'.., -� hfN.v �'�. �m : ssw� � � �d�:� d i .L.-c.. � /� ;e /!S.'�'.�'� c i"' L �pG� /YL�I� O{� �'Yi c.. G. � � o ✓G� `1'/� Ge. {�/ J ftc- � 1 /�:`/� O, U�C� �Ci S�o��Je V .� �� -flY c'-tn J�ls //r�./L_c'] v"1 /"_` � C.1/lYI /11N.w i�� G A � G�r✓� �CJ /�+./ D IP /G . A yI'1�LA �.� � /�f S/ JY�C < f �e/�,��S�,P -�-� ��..s /�Ce;, 1x,: l-f 5,�„�e �-le_ «,lc� .,✓�s es�6G.s•Ec� u, ye.. i� _ �a v, The information included in this application is considered private data according to the Minnesota Govemment Data Prnctices Act As a result, trus information is not released to the general public. (OVER) .� PERSONAL REFERENCES Name: 5iM � �, oa Address: /s3�. 6�ir� 5� — S� Phone: (Homel �v z/• �`/ �- ��d Name: Adc;ress: / 5 Phone: (Home)_ Nazne: Address: / / Phone:(Homel ) , /+1 ;o �} asr�,. � - G �ai � 3 i�v. �� -�_ -3��v� 4 - 5 f, /�.., Reasons for your interest in this particulaz committe !�r iH� �a . S w--,�� , �e 45�onJ �%v +"'G�iJ � GC � ca �� ,'S r.ei� c ,�se � '� G.' , �' .:, �c Lo.-,�'a.. i ✓�C, v � r�e,'s`� i�o� Have you had previous contact with the committee(s) for which you are making application? If so, when, and under what circumstances? `fC3 ,z �i.➢re G �,�, �/ ,� i � _ is� ._ r/-� -e r+�s� �%�s �'r � ,O.�.s7� In an attempt to ensure that committee representation reflects the makeup of our communiiy, please check the line appticable to you. This information is strictly voluntary. �White (Caucasian) _Hispanic _Black (Afi American) _American Indian or Alaskan Eskimo —�ian or Pacific Islander _Male _Female Date of Birth; 2 'L �'�� Disabled: Y No �/ _L_ If speciat accommodations aze needed, please specify:_ � _ �_� � . �_' � ., O a.. \oo'j �`�-�._ . �` S�; ,� _ .. How did you heaz about this openi p? fu //e,-, `yr.e„' 0 O'� �C C1 Application for Committee, Board, or Commission Please return to Mark Engebretson Mayor's Office, Room 390 City Hall 15 West Kellogg Blvd., Saint Paul, MN 55102 Phone:651-266-8533 Fax:651-266-8513 The 6lirtnesota Government Data Praccices Act (biinnesota Sia�utes Chapter 13) governs �he C�ty's use of the informa�ion contained in this application. Some of the informacion sought in this application ic privare da[a under the Act. The requested information will be used by the appointing au�hority to carry out the City's officiai appointmznt responsibilities. You are not required to provide any informacion. However, failure to answer the application ques�ions may cause che appointin� authority to reject your application. The majority of items contained in �his applica�ion are public, including name, address, employmznc, skills, trainin� and experience, and are therefoce available to anyone rzquesting i�. The remaining items on the appticaiion form are classified as pcivace. The privace data i> availabie only to you and to other pzrsons in che Ci[y who, bzcause ofwork assi�nmznts, reasonabty rzquire access m the information. Name � t�� I�) �� l...UTJ� Homeaddress �� {k�J�-tUr.�b � �-i 1�1-kt,iL. Mr� �JS�D� ciry sca[e ��aI�4Cil.1�S/S � E-mailaddress C'� Cy Cc..�b Ct�✓y� Planning District Council ((� -�p��y `�� City Council Ward � Preferred mailing address ��u,v,,,,R,� strce[ city ,t `� sta[e np Occupation ��f�,�tti�,iS{� �¢�T� �,��Gv�r..� `C: i�%��,,. n,: � t Telephones �p ��. Pleaseinclude Area Cotles Place of employment _�G�'��( � �� j � U Employment address Committee(s) applied for �c1 A� �.i �.t v �4'hat skills/training or experience do you possess for the committee(s) for which you seek appointment? 1" IA�A�.�"EF-��11 ' �"'ZJ2Mt_2 V.1". ��DU4Ll iLl.iOt.� Co� M-�k2�GT1n;C-� - E�.c; Aa`��"T�it�7NC7ItittksZKE�f rJ(-� Fi2M ��r•.�u►� �� \ - r Lj-l�* i2 , �vr-t� P C CC� �.1L1 � � i s P.ov1So2� t3o1kR-� Un�r.>� �-t-o+�n� L�,m�4-t t��rJISTiLICs �.:/12� 1� S�n� S �E7LV� C t � n� ��c ��iiz J S page 1 of 2 ;" Personal References Name J �7C� Address � �� • Telephones 'Z=�. Piease include Area Codes home Name Address Telephones Please inNude Area Co Name Addre,s Telephones Please include Area Codes home p7,_�o0� work work work other other other Reasons for your interest in this particular committee (.}-t, N+a t-1 I r.� P2.vvE Have you had previous contact with the committee for which you are making application? If so, when, and under what circumstances? r i In an attempt to ensure that committee representation reflects the makeup of our community, p]ease check the box applicable to you. This information is strictly voluntary. �"White (Caucasian) � Hispanic ❑Black (African-American) � Asian or Pacific Islander � American Indian ot Alaskan Eskimo � Male Female � Date of birth Disabled: � Yes No � If special accommodations are needed, please specify — How did you hear about this opening? '� �(�� , C �; t-t�vLG t� ClC ��/1 � I� S � �"`� �r ,�(-{-� �r : :.. : t . - � T � . page 2 of2 "' " _'__ "___ - �.��..,_ �..,.__ �.<ccco__.. r.�..,_. � � Application for Committee, Board, or Commission n�-'�001 Please return to Mark Engebretson Viayor's Office, Room;90 C'ity HaU IS We 55102 Phone:65i-266-R533 Fax:651-266-8513 The Min¢ceuta Covernment Datn Prar.ices Acv (\Gnncanca S�a:cua Chap[e[ 13) govzrns the Citv'e use oFxhe informa�iun coa�a�ned in this %D➢>>ca;ion_ Somc of �ht infnrma[Epn <ough� jn this npplication i> private dacs endcr thc Att. Th< reqacseed iaformation wi11 b: ys<d Cy �he appoin�ine ai;Loriiy :o earry puc ehe Cit��'o o;(ic9a� appointr�en; rcepvn�ibili�icn. You s�c no� requircd w prov�cc aey inforr.aci�i�.Hpu�cvc�, failure to an>w<r ;hc applicsuon quGatin�� may cacse tfie appoincing au,horiry m re;ec� yair spnlies:ion, T6� m3jo�ity of ittais contnined m �his zypliee[ion are public, incicding nume, address. employmen:, sk�lls. �rainine and cxpanaaca, snJ are ;hcroForo awoilablc m aayonc reyacsung �t "fhe remainnna items on �he ap�hcac�on form aro clascif�et ac p The priratc dx;� is avaita6le on[y i� ; uu and to othcr persocs ia thc C w�ho, bccausc ufwork ass�G�mcnec, r<�sortab:y require acccae w thc informacion \amc {� � _ _� /J Home address � c z.p Tclephones /�� C�S Ll'��o3 / i� /gc� 7��5' Plvn�cmcb.d<A C d I�o�. u�`��T-"" lax L-mai] addrecs Plsnning Distric[ Councit City Council Ward Preferrcd mxilina address s�:« - �;t ; .:�« —:� Occupation � v.� Pe 5 C��-�-___"_�-;� �'.<,M P1ace of employment F e �� l� , { - i � a� "'` ,,/ Employmenc sddrzss „jj9� � � k �� . �1 �r, � O�/`� Commettee(s) applied for �� F'� �� (?o�o Q_Lr What gkillsl[raining or expericnce dq you possess for the committec(s) for which you seek appointmcnt'? pa;e i of? a.. . / / Personal Referenccs Name �� Address C._ aGC >_.� r.�. _y O'i. -�o o'l Teicphonc, (�yy • t�73o PlcvseincluBeAreuCod<i hJme work e�'r.cr I�ame� �..1�_�_�S AaaY�GS �3�9 ��,o_�„t _ t� Telzphones��7_ �� Please Indude Arcfl Codcs hosc work otte: Namc �,. }1ar'la�..l�r Address �r �'�� — Tcicphones �;�- y9o1 Piease incinAe Area C'ndec ?�ome wprk o��er Reasons for your interes•t in thi; parcicular commictee �'o.,r�..,.e .� o6-,+ �,ah .� Y \ T � +� �j�,i Have yo�: ha3 previou� contact with ihe committec for which you are inaking application'? If so, when, and under what circums�ances? In sn sYtempt to ensure that committee representation rcflccts the mskeup of our community, plcase check the box appIicable to you. This information is strictly voluntary. � Whice (Caucasian) � IIispanic �Black (African-American) � Asian or Pacific l�landcr � American Indian or Alaskan Eskimo ('� Male Fzmale � 5R" Disabled: � Ycs No� If special accommodacions are vezded, ptcsse specify Datc of birth –alp_ / _ How did you hear about this openiug? ��Q pagz 2 oI2 TOTqL P.p.1 �� O �,.1DOR Application for Committee, Board, or Commission Please return to Mark Enaebretson Mayor's Office, Room 390 City Hall 15 West Kellogg Blvd., Saint Paul, MN 55102 Phone:6�1-266-8�33 Fax:651-266-8513 The Minnesota Government Data Practices Act (Minneso[a Scatu�es Chapcer 13) gorerns �he Ci�y's use of thc informa�iun coneained �n ehis application. Some of the information sou�ht m this apQlication is pri�ate daca undzc the :1c[. The requestzd informa[ion a�ll be ustd by [he appointin� authority to carry out [he City's official appointment rtiponsibilititi. You are not rzquired to provide any information. Howe�er, faiture to ans«er thz application ques[ions may cause [he appointin� authority to reject your applica[ion The majonty of items contained in [his application are public, includin� name, address, employmen[, skiiis, vaining and experizncz, and are thtrefore available to anyone requzscin� ic. The remainin� iiems on the application form are classified as privace. The private data is avaitable only t� you and to oeher penons in che City who, bacause of work assignmzn�s, reasonab{y require aceess to i6e informacion. Name G�/�A�-A � �� Home address %'`/� � Telephones (qs /�- Please include Area Codrs E-mail address ' � I/Y/ c� l��" -. G � �' £� z�p Planning District Council � Preferred mailine address ��l0l1 Occupation Place of employment � Employment address � / � �� work �F �� ry l i� ` �S � statc zio Committee(s) applied for ��2�i S /F � � � � � _ What skil(s/training or experience do you possess for the committee(s) for which you see!: appointment? pa�e 1 of 2 /� �� — City Council �Vard -' �' �Av` //�' S S 0 / O�-�oo'j Personai References Tvame �'�' f�-i�L� �. �t2/��2 Address ��/� p ��, ��E � � Telephones �j j)— �p 9� p� 6rS � ____� Please include Area Codes home worA pthec Name Address Telephones Please indude Area Codes home w�orA other Name Address Telephones Please include Area Codes home work other Reasons for your interest in this particutar committee ,ui'Ji„ ' ��% ; ,,'�-2�y Have you had previous contact with the c��mmittee for which you are making application? If so, when, and under what circumstances? � z� . /� ,�� In an attempt to ensure that committee representation reflects the makeup of our community, please check the box applicable to you. TYiis information is strictly voluntary. � White (Caucasian) � Hispanic �Black (African-American) � Asian or Pacific Islander � American Indian or Alaskan Eskimo �Male Female � Date of birth //a.7 G1� Disabled: � Yes N� If special accommodations are needed, please specify How did you hear about this opening? __ ,�,�g%�� page 2 of 2 �° . C�?-�ao� Application for Committee, Board, or Commission Please return to Mark Engebretson Mayor's Office, Room 340 City Hall I 5 West Kellogg Blvd., Saint Paul, MN 55102 Phone:651-266-8533 Fax:651-266-8513 The Minnesota Governmeni Data Practices Act (Minnesota Scatuces Chapcer 13) governs ihe City's use ot che informa[ion containzd in th�s application. $ome of the information sou�h[ in this application is private d'nta under the A<t. The reques�ed informaiion will be used by the appointin� auehonty eo carry ou� the C�[y's official appo�nement rt>ponsibili[ies. You are noe aquifed to provide any inCormation. Hoxe�er, failuro [o answer thz app�ication ques[ions may cause the appoinein� acthoriry m reject your application. The majoriey of irems contained in chis applicaeion are pubhc, includin� name, addrcss, employmene, skills, vainine and expenznez, and are thzrefore availablz to anyone requzs�in� ic. The remainin� iiems on che applicaeion form are classificd as privace. The privaec data is available oniy to you and [o other ptrson; in the City aho, bzcause of work assi�nmen[s, roaionably rzquire actess to [he information Name Nora �'4l Home address � �j7 f Telephones _ �, Pleaseinclude Area oAes ,V f]C E-mail address �_r rn � �i � �� Planning District Council ((� �fi�,� ��n �/ City Council �Vard Preferred mailing address ��,,� o Occupation Place of employment Employment address _ 33�. (M � �1 s6� �� .1 —� ( f�d Committee(s) applied f'or ni��h �,� (/l�nni� �/ � i, c�. ✓, � ��a-,,,� '-l-d- . �Vhat skills/training or experience do you possess for the committee(s) for which you �eek appointment? pa�e 1 of2 � ��" 4 � Personal References Name Address Telephones Pleaze inNUde Area Codes home work ocher Name Address Telephones Please inciude Area Codcs home work o�her Name Addre�s Telephones Please inNude Area Codes home work other p a,_�od1 Reasons for your interest in this particular committee� 1 _____� S�Y'I ( �A» lw � �/l(� G�LLt f' Have you had previous contact with the cornmittee for which you are making application? If so, when, and under what circumstances^ In an attempt to ensure that committee representaYion reflects the makeup of our community, please check the box applicable to you. This information is strictly voluntary, Vhite (Caucasian) � !{ispanic (� Black (African-Ameiican) � Asian or Pacific Islander � American Indian or Alaskan Eskimo � Male Female �� Date of birth � Disabled: � Yes No �" If special accommodations are needed, please specify Ho�v did you hear about this opening? __� 15�Y i r� / .r�n n �^ � page 2 of 2 0 ;� O �--�� Application for Committee, Board, or Commission Please return to Mark Engebretson Mayor's Office, Room 390 City Halt I S West Kellogg Blvd., Saint Paul, MN 55102 Phone:651-266-8533 Fax:651-266-8513 The Minnesota Governmen[ Data Practices Acc (Minneso[a Sta�utes Chapczr 13) governs [he City's use of the inCormation con�ained in this application. Some of the information sough� in this application is private data under the Acc. The reques�ed information will bz used by the appointing authority m carry out the City's official appoittcment responsibilities. You are not required to provide any information. Howeveq failure �o answer the application questions nay cause the appointing authority to rejec[ your application. The majority of items contained in this application are public, including name, address, employmenc, skills, training and experience, and are therefore available to anyone requesting it. The remaining items on the applicacioa form are classified as private. Thz private data is available only to you and to othzr persons in �he City �vho, because of work assignments, reasonably rtquire access to the information. Name Home address ,�� O 5T s . .,..... ., Teiephones �S� f/ff � Please include Area Codes nom� work p� E-mail address �y/,4�(',� � �J /�15�� 6�"L Planning District Council /p City Council Ward �— Preferred mailing address Occupation /� e Place of employment �C�.� C-� �,� 5 ��,� p�- �.�/ Employment address �20 /�YP7�� o�G Committee(s) applied for /L� A G � What skills/training or experience do you possess for the committee(s) for which you seek appointment? C�"l �/ST�.�C � /� C � �/�ii �Tv �' page 1 of2 � O�-�O°'� Personal References Name Addre Telep Please include Area Codes home i�'ame Address Telephones Please include Area Codes home Name Address Telephones Please include Area Codes home u�ork other work other Reasons for your interest in this particular committee Have you had previous contact with the committee for which you are making application? If so, when, and under what circumstances? In an attempt to ensure that committee representation reflects the makeup of our community, please check the box applicable to you. This information is strictly voluntary. � White (Caucasian) � Hispanic � Black (African-American) � Asian or Pacific Islander � American Indian or Alaskan Eskimo � Male Female � Date of birth Disabled: � Yes No � If special accommodations are needed, please specify How did you hear about this openin�? page 2 of 2 work other ♦ o a- -�� '1 Application for Committee, Board, or Commission Please return to Mark Engebretson Mayor's Office, Room 390 City Hall 15 West Kellogg Blvd., Saint Paul, MN 55102 Phone:651-266-8�33 Fax:651-266-8513 The Minnesota Governmenc Data Practices Act (Minnesota Stacutes Chapter I3) governs the City's use of the information contained in this application. Some of the information sought in �his applicacion is private da[a under the Acc. The reques�ed informa�ion will be used by the appoincin� authori�y to carry ouc �he City's official appointmen[ responsibilities. You are no� required �o provide any information. However, failure to answer the application questions may cause the appoin�in� authority m reject your applica[ion. Thz majoriry of items contained in this application are publu, including name, address, employmenc, skills, training and experience, and are therefore available to anyone requestin� i�. The remainin,o, items on the applica�ion form are classified as private. The private daca is available only to you and ro other persons in the C�ry who, because of work assignnents, reasonabty require access to �he information. Name Home Telep: Piease / / E-mail address __� � `j�� (�� //� �• Q r Planning District Council �� City Council Ward Preferred mailing address Occupation Ylace oY empioyment 9E� Employment addzess ljj�QQ �C/ i'�C(� �G� �, � (� �� Committee(s) applied for �/��/ �fZGf �l�r P Gy�f 5 � v / 7�?� �{.� r� i��PC�� Gl t �Vhat skills/training or experience do you possess for the committee(s) for which you seek appointment? •— .OYG� i � C � /n/�h' f . - -�/�-7 G(Y�/ 7 �� page 1 of2 R Personal References Name ��/� Address �.�"�C' - ��YPCfOT' �d.-l�o`'1 Telephones � lJ�� U/�� -��'� r ��C/ Please include Area Codes home mork o[hzr Name Addre Telephones 9�� J� ��3 �ia �0�9 PleaseinciudeAreaCodes homz_ �cork other Name Address Telephones ��'�� 7��j ��8� ��'�y� O//� Please include Area Codes home work other Reasons for your interest in this particular committee Have you had previous contact with the committee for which you are making application? If so, when, and under what circumstances? In an attempt to ensure that committee representation reflects the makeup of our community, please check the box applicable to you. This information is strictly voluntary. �White (Caucasian) � Hispanic �Black (African-American) � Asian or Pacific Islander � American Indian or Alaskan Eskimo � Male Female� Date of birth �—� ` J�/ Disabled: � Yes No � If special accommodations are needed, please specify How did you hear about this opening? �h �/ � f �� Y /�� yY1 eP7�/�l�p'age2of2 ✓ �--� S�'U/ �u� v O a-- �u c'1 Application for Committee, Board, or Commission Please return to Mark Engebretson Mayor's Office, Room 390 City Hall 15 West Kellog� Blvd., Saint Paul, MN 55102 Phone:651-266-8533 Fax:651-266-8513 Thz?.finnesota Government Data Practices Act (Minneso�a Statutes Chapter 13) governs che City's use of the informa[ion con�ained in [his apglication. Some of che infocmacion sought in ihis appiication is privace data under the Ac[. The requested information will 6e used by [he appointin� auchority co carry out che City's official appointment rz>ponsibili[ies. You are not required to provide any information. Howeveq failure to answer the application questions may cause the appoincing authority to reject your apptication. The majority ofitems contained in this application are public, including name, address, employment, skiils, [raining and experience, and are therefore available to anyone rzquesting ic. ihe remaining i[ems on the application form are classified as private. The privace daca is available only [o you and to other persons in the City who, 6ecause of work assignments, reasonably require access to the inEormation. Name I nri � `n, c< < Homeaddress �� V � R\iG �n/ S� PF}v` vnN Sslt stvicet eiry sta[e vp Telephones (p51-y�`�-S 373 (�SI' 33�-��y7 PieaseincludeA C d home wotk fae E-mail address LS PI t SS A /�TT R� �� Planning District Council �� City Counci( Ward 5 Preferred mailing address Sq�� ys cib bilL sacet . c�ty staee z�p Occupation UiSVi�L rn�R�tiflnlA�sE2 Placeofemployment (-}�rL13�.RGE(ZS Employment address Rl7S E Q/��.E � N j E� �{ZOS E v� LLE 1�.r�/ Committee(s) applied for N /�� Vhat skilts/training or experience do you possess for the committee(s) for which you seek appointment? Qisi (��r Ten3 6oPc2 rn�m(if(� page 1 of2 Personal References Name —r_ Address Telephones '_ Please include Area C aJ �'� 3 � �� home N a m e +,-. work Address Telephones -7� Please inciude Area Codes _� S' •, �� 1 home � - Z Name v� ._ w��k Address Telephone c^ � Piease include Area C des� ^ 5 Zy home other o[nzr work -_ Reasons for o�her your interest in this particular committee . �..�-_, ._ .i e . T n_- Have you had pre�]ous contact with the committee for which If so, when, and under what circumstances? you are making application? In an attempt to ensure that committee representation reflects the please check the box applicable to you. This information is strictly voluntary. makeup of our community, , � 1V hite(Caucasia n ) � Asian or Pacific Islander � Hispanic �Black (African-American) � American Indian or Alaskan Eskimo � Male Female � Disabled: � ye$ No �ate of birth Ifspecialacc � modations are needed, please specify How did you hear about this opening? � S�c � c.� � O o a-- �� page 2 of 2