Tim Kirk Application Mir
Fridley Civic Campus
7071 University Ave N.E. Fridley, MN 55432
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Fridley 763-571-3450 I FAX: 763-571-1287 I FridleyMN.gov
Name Ts4v., Y...1--\c
Address -2A . .c,"-,,( ' ,fc i\I c
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Home Phone -45 .D II ' 4 Number of Years/Months Resident of Fridley 11.5 lS e.“r
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Address } � 1�1 (��(', � �';vac �✓�_ �� Cc % 5`1i :' ,
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Please rank in order,the commissions on which you wish to serve.(Leave blank any Commissions
on which you do not wish to serve.)
Charter Commission
Housing & Redevelopment Authority
Planning Commission
Environmental Quality & Energy Commission
A. Parks & Recreation Commission
Prior Experience on City Commissions, City Boards, etc.: i 0 t y i"r-Work Experience: 5 ��cc c4 a-ca4,--,A iecc\.er C'ey _ ', ,zp 1\c>me- Cc-';t, r t - ;r--
1 Civic, Professional and Community Activities: ,S,tKekai Sct4 J c oct�%, ---t. 19c,-- f a J
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Why do you want to be on a Fridley commission? T-', l vhn
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What skills, strengths or abilities do you believe you will add to the commission?
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Does your work require you to travel? IVQ How often?
Additional Comments: -I em S O �- �a' >) J�5�I��� 14/1 '^ au ' :YJ
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References (Optional):
Name Address Phone No.
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Signature Date
The information provided by you on this application will be used to determine your suitability for
appointment to a City of Fridley commission. Participation as a commission member is strictly voluntary, and
you are not required by law to provide this information. If you do not furnish this information, however, the
City may have difficulty determining your suitability for appointment and contacting you. Under Minnesota
State statutes, only your name is considered public information upon appointment. Any other information
on this application is private data and will be accessible only to you, City staff or as provided for by Minnesota
statutes.
Please return the application to Roberta Collins,
City of Fridley, 7071 University Avenue N.E., Fridley, MN 55432.