HomeMy WebLinkAbout120713 - Oath, Statement of Officer, Open Meetings - Mary Margaret Carmichael (
* .....„...:, .4,. { sa SENIOR ADVISORY COMMITTEE
APPLICATION
CITY 01' C01,1,1.?G.L STATION PARKS AND RECREATION
Home of lextr; A &M University' 1000 KRENEK TAP ROAD I COLLEGE STATION, TEXAS 77840
(979) 764 -3486
PLEASE PRINT
1. Full Name: I Ka c Y 1 LM U r C ci..r.z.,1 1 i C C1 )" !Yl 1 C. A 0 c( I
FIRST ) p MIDDLE LAST
2. Home Address: I `t- () ti D G 1"N ue. r CI ) r U e- .6
STREET CITY ZIP CODE
4. Contact: 1 97 - 7 03- ( 11 1 i ;5 .' - I 2 L.f, . -0 ? 0 0 1 1h1me„ 3 6 a)16 — n4, I, IMOTI
Information HOME PHONE CELL/WORK PHONE EMAIL
5. Residency : J) 0 .3 4 en `f 1 / 3 1 I / 1 I C 0 S l e R 0 CA I
Information VOTERS REGISTRATION # YEARS AS RESIDENT OF CS SUBDIVISION LIVING IN
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Information OCCUPATION *If business owner, NAME OF BUSINESS -
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Please list any Boards /Commissions /Committees you currently serve on: r
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* *All applicants must be a College Station Resident & Regi tered Voter
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SIGNATURE OF APPLICANT D 4