RECEIVED
ity Clerk's office
FortCollins
SS
APPLICATION FOR COUNCILMEMBER ~ DISTRICT 1
[APPLICATION DEADLINE: 5:00 pam. on December 26,2018
{inte applications wil nt be seceptedicansidered)
PLEASE TVBE OR USE BLACK INK. ATTACHMENTS To APPLICATION MUST BE UM TED TO TWO PAGES.
INCOMPLETE APRICATIONS MIL NOT 8€ CONSIDERED FOR APPOINTMENT.
FRetur complet eppcton:
In porson vo Ena
iy Clet’s Ofce ty Clee offer etyeer@egov com
5300 LaPorte Ave Po oe 500,
Font Cosine, CO 80522
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RESIDENCE ADDRESS: _ 3299 San Lake Dave Fo Cain, CO oem
oMe Prone: WorKPwone: 712269974 one: _212205:9874
wat: _eotoe@oral com
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HAVE YOUSEENA REGISTERED VOTE
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‘CURRENT occUPATIONEMPLOYER:
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