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Staff Report 4.B 06/15/2015 - Part 2
n r-- \ 0 M �O 9, .� 1C O •a •� N �{ L O L 2 � •� RNR, W •u L. u `W LL, Q n II O CD CD C� O CD (D CD n O <D N CD Q o O D n o. m � C7 o N =+ �. CD n CD O_ n tD Q n II O CD CD C� O CD (D CD n O City ©f P -;Wzcm ' Calzfor, z'a RECEIVE �- CityB:o'ard; Corrimissior and'G.ommifte.e Application JUN •V City 640 's.bffl6e 1 a g5 �'1``Fglih: °Syr:ef • Ret'aluma >'.C, 9'4952 x;70.7.. 778: 4360. • eitycl 'erk @'ci:petalurna..c�.E(� o Instructions: Use this form to apply to serve on any of the City of Petaluma, California's Boards, Commissions, or Committees. Please fill out the fi s 0 completely. If a question does not apply, type or write N/A in the space provided. When completed, please forward to the City Clerk's Office; y of Petaluma, 11 English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. If you have questions about this form, p1e coil the City Clerk's Office at 707.778.4360 or e -mail us at cityclerk@cl.petoluma.co. us. p Q N.csFn'e: N. J�b C' 6 C�C3 G{�V1 Y l D P :H,'otneAddtess .C.it 'Scat :e:gnda` Code't; YY: -Phone: (if:apporrttect; do; yqu*.Worit' this: Aumbq'r to:;b6 availob'le to :the.• publie?J E- Mtti!'� (If appointed, do yov•want this address to be avoilgble to ;'YES' : ❑,, . , .. . ' the public?) YES; �. -NO ' oQecltnimis if so o iowlive fhipo ig ?:' ❑ YES 14 NO A Are•yo'u a-'re'gisterdd;vofer.' in: R'efalrim'a? if soy for how, long? S ❑ YES ❑ NO t4A. � ` 4 b bS •"bi.3.'1 V�'ba.s�3l�a -1 a }�•a,y,. 4�cll'�1 � Fis�IDJ c%`a --) �- �;'Lt'2't � -p/tA brig a� d su r ZA 1�:DuZ'J a� ::.'t .� '�P:•::i�• .. � •..r• ii: �r4.4 `'t . . ' i t..,��t•t•.i•.a'.:,•. •:. ,, ,. .. .. • anpy.noA. sari p am }:)al3 sat og bjuaLuuaano'O sno[naa :91 }11 aor :jbXoldua3 }uasaad ON S3, ON S3, .. :. .......... . •.. .. ,.. .. _ ., .•. 'z�(Isnolnaad'�salpoq.�( }t0 'sal 'pannaitia 'uo o �( � P q, #.0 aay }o aQ s1y} }0 6u1 }aatu p papua{}o rio�( anpll Ib'•sly} ao} paildda ao }u► p6 as nog( ana}{ `JI D 4�SS 1u71 Wi O '17 ! . s r• ssjiuuo),'spa.og �}l J6440. ' • . ••`• uo a as o� ?5.0ij�inn.,no r: ,. ( :an:'aoCoi{ ;}5ai anokb } <p9juiodda.}ou }I 10 SJ06i•gs- saal10 94Isnw n0x,,aq{ I ijw.oJ ,(losinpylozuag ayj•uo 0ni0s•0j:a{oN 'aa4iuiwo 1u0rssivaua00 'paoog ;, ,;4.: ;. 4M00-1 }b 'D• ao GlYjC:Qr <C.h'ari %cib'(e O;rgtrniza :onao ~whic:h,yovifi'c we.be:[o.nged, Poritia �.O,ffr.Ge • teaei;:;dnd; Dates: Cau.��.t Ca,m4t -ire C.r�cls S�a�� L3<zc�rcl `- his Nci� ('J<sas I°t13 C-wa Lt G J i t-' ' - Fe t1 , ? , c , Q - 0 = L LCI tt- I C Y i2 1'�cz.;t tc-y (SSf1Ci�'ai2,r,,� ►�,•�y � Cj c.�,la � lam' cc,�ira�m. i�d ca...ccE ULI,�W\.b�.� � �.CZ., awc�2. S yvtz..tiS iei �-s � 1�t�alklt� L L`1 W ra :Sp dd. ial Int resf 's' /Sf<ill's.'%Tydlents'would y.db..,�61gto.t'hi� Boarei;'Comtni'ssion`, or. Commit#ee? ' 'l ro blt'_rn 5Q1 t�l rt � €a In a.l �-t• i C o..,\ -k�'\.\ v�.l�`t,r, c1 . Col[ e:: ge;• Professio' nal;- :Vo'catpnal', Schools 'A#fiend -bd'(Major'SUbject, Dates,'Dedre6 /Date): u 61 L � �r S �"�:� ©� fk-t- ct,�� -tea- -• (fs I °i `7-a �, t p�[ C7 - Lua � no n no{ sanr aaf o o :/wtost b i o� p m:A.0i djrp'&;t "a "�wwo ,ao:uoisst uuio•'.. ; ai o" ' =si ' > o :�a wouitb- 9wooa. •'.o .'��tr m nor( �('� nA suosaaa•a r� s•a-saa . r • .,.': .. ....: :� : ' � . � ... �;, ...,,; ' •,;:: :��;. .. -.� � - :. ;panlaoa�j �Uoi���lu'600a}�.:�o� spacin�y ic»ads s;f -ere-.any oth: erJh formdt( an• thai :yo:ti••fe:el:watiCdirSe',U'd i46 the City Codn•c'iCfn reiView(rjg'your app'licat('on? :L C\c5 v1 d-% l ;, v e c.cv � - �1n.1,n. -�- ln.c.. t'�e'rc�t t.�.v�na � � .� t � v�ti : -�• s �h w e.v' �" �-• + �.C�,�I °u L V V 2,C� CL.'�' J�'i �. VA o U_ v-,A- C'..t... v" V L �. w A V � V�, �•-:. °L 3-5 Are; :`roU :gssoc'iat' is wifh; .,a.n' 0i "ah-ratio'nj'E- i'n-0fc.iyrie'nt .*th�dt rrii ' ht be' deorned; a'.confl'ic #''of.`interest in perfo.rrning,youri,duties . if Y Y... 9, p, Y.. 5 ,,. - . , : - .�..., a.. 'e? t. 'i'' pogsl tion ❑ YES ® NO [f' es- Pease state mine.. of; O' rgaiaizbfto•h %E'tlp('oymeii #':• NA C(ty p;o.(:dy directs, all .app'oin #ed,, advisory',} j'odyj.'memh'ers:h'ot;.to••voto on matfers were,%fhere: exists a potentia -i c•onf((ct of•inteTest. VYuI' duyou,= e: wi( hrig: fo ,ubstairi,, #ronz`vtin•g.ifi.such a:'conffict'arses?;'. YES 1 _! NO Hoyv' ?chi` '.ou'he'dr db'out this o, enin ?' I. -y p: g On time and Conoe+reso?;'.en A G-ta.55 cv, �`�CC,r 4, pa App�icant'.'s` Signature • ' :. `D'a #e. . Revised October 11, 2012 LIM US O CL 0 0 0 3 3 iD sieE)A+O ON Slk CL Y Ullllir�� X ml -E sjeeA+O ON S3,k rign omfa- -g;3 q'i flt -�96-b6 VO 'ewnleled A 1 016 2 R%- I IT, �V r ema—, NO sn jo .9ogio A1ID,9(41 1103 "n to llow-a oqop,,azzzoz jo soald lwioj s�pj 4noqo suoil.5anbGAIDLI noA p Apb iqqj Aq PGM,9lAa-1 aJo suoilooilddo IIV 736M VD 0wn10p9j 'jigails Qsy6ug I L lownlojej jo Cr 113 001440 3,4J,913 11413 GLII ol pjo/yuoj asoald 'pala/dwoo uaLIM 'paplAo-id goods at4l ul VIN 0411m -'0,qdAj 'Aiddo jou saop uollsenb o p -Xialaldwoo �D :suollonilsul "N -ijoj aq� �no 11IJ i9S0Gj,4 '3,9,94jjLUW0D -10 'SUOISSILliwoo IspjiDog s,qwoj!IoD lownlolal jo A113 iDL14 jo Auo uoglues of Alddo of Lujoj S�p� 0.�n f-I 1 bA r, TT rD di W. u W.-PR c 6, b O (D . . . .. .. (D W r :rn .-N WI Senior Advisory Committee Cl YES ❑ NO ❑ YES Cl NO .5 Sandalwood Estates, LLC Community Manager N/A OL61 aunp juawdolaAaCl pooqpjiqo ApeA c]::I-A W N -sjoivas joj buisnoq ajq8j!eAe;0 qojeasaj jEqjew auijno�j OleOOApe speou jejoads/m siques'seomosei uewnH -sjeaA +0 jol fqlunwwoo ino uiql!m sawoq builuej buipie6ai siquasim bul�{jom -sjeaA +oC jol saipmwoo GWOH el!qoN buipjabei sanssi ;ueplsaj ;o SIGAGI Ile qjIm jeep of alqe -sjj!� S -1 4: >::u...:. M, -;ll gig g �!Xtg sn Uil . . . . . . . . . NOR, JOJUGA all-d juez:1 Jalueo �eesj AjeN-S-Loo Y Special Awards or Recogn� #Ion Izecelve'd i Certificates of Appreciation from residents annually, i,..'ii r.. ,.. rr:.r rY.r .,— „:h -.. ,, -r... ,. , i ., +i•h .r. ..�.:: i-•..: }y.:.:i �:: .. {.:..�.,. .;•., r� r -rr} v- :'.�}�:.vv {v _..r_.- . .vx - .Xx.c... r. _ �._a+ t _. r' � ry,,.- {.yi.: i'tl''c.. ,:_- �:t'cr_ };: i?:V' {:`:•.,,,':�; ,: ti.:: �;.; :•i''..; >L.k!i:'c ct -t3 ._ � +.. _,- ,z_.i -., r �,. :_ i .r �... t , orb •:.i'{h�_�:..R .� - »u i .1 . i. r,::,. a• , i rl• F t r r� ..�.:h.e.- :t_-- '.".:.:.r ..(.c_..4t:- ..f+tt^`i a;''r,. a.F4r: -.,f 'I: �!• y -i_.r al .. `•r ��r.: ::cm .ri..H -.i _..,S,q 14.i.. .r: f'.,:�k. vyr _.ia..r ::,•- .,'.Trf »a.. �'....:r. ...r.. r , . ; +-: -.:.. . sC.j r' —.:. a .........: i r ., r.+c- :, ....! .,. _ ,• r i - -n ti �.tF : r _.: r. :_ .: �.',- ,`.-- f".,.� ,- Ij: -i -„ r 1t -. _ 3+ .�rt"�' - �. ?'t "' . � -r:d, � r-. ... „ ._._ :. ,.�.'r ,.._ . .,,:n' F. , as 7irn:. �. t - .z b7:,,:n.. _1.x :crr:-%x�:•,r:......: - :. . -- ''-'r , ,,. s...,- _L.r.: ,j.ti:. x, },.. :r_. .:.cttt! =_`�`. .i "� �(' .n:,: 4 f r . -.+-r. . r:. :.r r.. -: I.. 1. .1 � t : ,...: > 1. ��_ •x'. 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F -.. ,3•.; +t :;ri;: -^i'i. i �..: '.- r._�_.�_= 2�_. t :a. r�i.h:� - z:. v.._.... .F,,. - ..: , � t,: - ...ti. � i-,.,._ : �._.. .r}Jx-Le' rE. t_ t ,. - +ti'a ,: ;ei+ t - _ „1-:::•'• r, t�.; -. q ..>,�.•. =-t �rr.:r -:..F -t r- .T. �n..r?.. -.._ ...: c;.:;,- .� -,.,. i. .FiT� __ .6r- .:.�":. =F:: ,-�. .C: '•:,:- t7;,:- ;•t -:-": +- ,- r•C -r�..: ,+, -.,: �,r: r: �- ,= �c;�r- S'ru.::,.: _ cam: :-'rr, ti�r� s' � >•: Jl,�, _rh_a __ _ +iii u �.}i:c...,._.....J,.. ,. � _,._,.. �. :.,_+:. -� :"�._. �. _ .,.._. r'r �*.' � - •;,'iF�tx�' -F •.: _t;? ._.�';'i. :':kv':: 21. { 4 rt =�N'" a: g,•- 1 ..a � .._.._ ..... .. .. . .. .. .. ..� a.x..c ....._.. t_ �G.. _._ ” ... . 3* •'cd 6 .i., �'a� +�i:.,�:,_�r.....tix.� , z.Y .•- -..;. s �:3_�. t•__.: :� .,3:= 1,�L.. __Lr.: nx__.. __. ... - - _•,- ..,_._ ...� -Y_.. ..r_•�. *�: ;.;i�?: - _�i' _ �,.�'..:. „i- ._.7._ ......... .........?,t- ,?...... :-r:. .: ",. {... ._.....��..... _.. :+, ... ..YF f.. d. : `�s- :- :a;_-__: �'. ..+ -s..: - : >rt.- :r= �'"iit'.`l:frwti-� 'J'� -... _ +•;.t+..�:;� To locate, retain housing for senior citizens. '-e a 4 City of Petaluma, California 1 City Board, Commission and Commiftee Application �; City Clerk's Office C r8�g 11 English Street • Petaluma, CA 94952. 707.778.4360 • cityclerk @ci.petaluma.ca.us i ¢ i � c Instructions: Use this form to apply to serve on any of the City of Petaluma, California's Boards, Commissions, or Committees. Please fill out the 1 Z completely. If a question does not apply, type or write N/A in the space provided. When completed, please forward to the City Clerk's Officel < of Petaluma, I I English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. If you have questions about this form, pt! C call the City Clerk's Office at 707.778.4360 or e -mail us at cityclerk @ci.petaluma.ca. us. ! 'z 4 Name: v Judith H. Hillery Home Address; City, State and Zip Code: i Petaluma, CA 94954 Phone: (If appointed, do you want this number to be available to the z public.) E -Mdil: (if appointed, do you want this address to be available to YES E] No the public. a W YES F-1 No Do you live within the - Petaluma City limits? If so, for how long? C1 YES ❑ NO 38 years Are you a registered voter in Petaluma? if so, for how long? M YES ❑ NO 37 years 90:41W WOO Aaosinpy aoivas ;o aia40 luasaad :saInQ pun play a3l}}O /uo141sod 'panaas army nog( saol 0 ani }oala /salpoa Ipluawwano0 snornaad paal }a� :aaAoldwa Wasaad ON S3A ON [-] SR k (Isnolnaad salpoq A#i� jay }o ao sly} 1ol pallddo ao 'pamalnialul 'uo pamas nog( army sal o i as o ,to st o Sul aaw n a ua noA army L p q •O y� yl p p ON saA 14014M os 11 zsa94Ilww03 ao 'suolsslwwoO 'spano3 A41019410 uo anaas o 6w IM nog( am 'ao 0 o s11 ano�(o a uloddn ou II I y p l _ ION jo saoa�t gg �scal ;c aq Isnut not aa{�lwwoa.taoslnpy joluas ay; uo a�vas o,� ;a }oN :Isaaa}ul Jo aa{}IwwoO ao uolsslwwoO panog Civic or Charitable Organization to which you have belonged, Position /Office Held, and Dates: PEP Board for 25 years What Special Interests /Skills /Talents would you bring to this Board, Commission, or Committee? Retired Registered Nurse and interest in our senior citizens College, Professional, Vocational Schools Attended (Major Subject, Dates; Degree /Date): Registered Nurse graduated Methodist Hospital School of Nursing, Philadelphia, PA -speou pus s}soaajul alegi • siques ewnls}ed ino 4o exellonn pu-e glleoq e ;owoid of 6uldleH :Apoq NosIApD sly.l }o aagwew o so pionnal Supponn aq pinonn nog( sanll.oafgo ogloads 40yne Bulpnloul `aa}}iu Luo:.) ao uoissiu.auo:) 1pioog siy} jo aagwaw a awooaq 04 ponn noA At4m suosoal ajD,ls asDala lanoC) u ;lpnr dad u ;iM sJsaA CZ :paniaoall uol }iufiooag to spiDmV lDioadg y Is there any other information that you feel would be useful to the City Council in reviewing your application? Are you associated with any Organization /Employment that might be deemed a conflict. of interest in performing your duties if '-appointed to this position? ❑YES 9 N If yes, please state name of Organization /Employment: City policy directs all appointed, advisory body.members not to vote on matters where there exists a potential conflict of Interest. Would-you be willing to abstain from voting if such a conflict arises? ® YES 1-1 NO How did you hear about this opening? My term is up in June Applicant's Signature Date 5/19/2015 Rew ,&October 11, 2012 SAL-94 g � saeaA 8 L ON [] s��, �6uoj os 3[ :. �awnjp ad :U! - -ja on paaa{S aa::n noit.a , gh, mg 1.. J ►. J 4Suol ao }'as' #I:: ::: }tw�j ii }r:n�tunjA }ad, �u} uiu }i,aA�� nog[ °o:Q' fl"N. S JI lz�r(gnd:` g :. 0N. fund: algplror o aq Q¢:ssaappt� s1yl �upm no ;op .pa1u(oi: e.d �J1 1laV±�- op.�p uroddb :auo�a: gds °algbld�?!b aq;o(�a wnu s( I jaweaa>f uesns CA.....: ...... o ` sn'go`t�utnlb ad'(o��dal3�t(13 4o sn stow -a -jo ogopi R _11',�oZ �o acvx) s,�Jalo Alto OL141103 y p(d lw.toj s1c1.14nogo suo14senb eAoq not jl '11ounoo Al(,-) at(.l Aq pama(naa aao suolloo1(dd0 IIV ",7361'6 d3 lown1ojsd ,4aaa1S gsjlj5U3 11 'ownlolad ,lo CL a3td10 s,�Nal�i� ate( of paOMao asos(d'paalduao3 uay •pap(no�d a30dS age u1 y /(y a((�n� �o add `�((ddo ( ©u swop uo(lsanb o �1 `�{(alaiduto3 <—,' Q � ag,(1no (�i� asoaid •saal�lwGUO� �Q 'sUOfsslututo� spaaoa s, a(uao�(1pJ '0wn(n�ad �o �1� ate( �o �tu0 uo an.ras o� �Jddo of uJ.ro� s1g1 ash ;suol(3na�su( W1 +_ I Y T Board, Comrnlss�on;: r Corrxmit#�e, of If':n0 In crest,.. ; ` 'appointed fo .ys ;u flr f cho)oe, .sire you w)lling tc+ serve on Nafe: To:serti!� on ti+� 5ehto�• �ld�Iscly: Cc�ntmittee ,'youmustbe:s�tl�p�t ��i yegrs of ' ., . o .t .e. rC) s, or C6.mm tt e es7`lf s wrr, Coss)on i hl h Senior v sory Comm tree e Nonprofit Program Manager, School Administrator P.. rev�o.us.Goverrtta�erifu( Bodies /f~lectiye Offices:. ou::fiAve= served, Posftio=nl0fffce :Held:and D.aes: Y Currently serving on Senior Advisory Committee 2013 -2015 term £86 b `IL-4uep9ao enllealslulwpb `oosioulead UeS 10 �4lsaanlun £861- lleuol}eonp:i `aaa6ep 'd'W `oosiouWd UeS }o �1lsaenlun �L6 G lle!}uepeao Buluolee1 Aae4u9w912 `Mle�aaS `leluao }llle }o A}lsaanlun £L6 L `A60101o0 `e9a6ap Vg `r eiea jeq `lelujo}iiep }o 4saemun {a}qd /aej8Oa- jsa}po iofayy }:pepu }}y slooy lnuot aoo `' }nuojssa }o�� 'a�aljo. •s}aoge dnoib o} suoljngla}uoo Oul�ew pule wale} a sa BUJsJom AO(UO 1 's}lsln flag} of iuenalaa aaam }egi soldol uo `wei6oid uoluledwoa blues eq} jo4 waa6oid je�eeds jsen6 AIq }uow le papinoid 1 -elseq aeln6aa le uo siolues jag }o pepsin siolues golgm ul `wei6oid uoluedwoo jolues a peslA19dns I `Allea-1 'siolues 6ulruas suopulueBao 11}oaduou aaglo g }lm e}aaoglegpo o; fl4lun:roddo ey} peq 1 '6uppeei ul sluepn }s Ajejuawale joVil o} siolues paulaa} pus pe ;lnaoej 1 'sieeA ino; jo; wei6oid 6upo}nj leuolleiaue6aa}ul sdjoO.eouelaadxEg clldv d ue pesinaedns I uol ;lppe ul tOululeil pip sluepnls eaegm segllloe} 6uisanu g }lm s}oaa}uoo pa}ello8eu I saleaA }y61a ao} loogos }lnpe ue ;s wei6oid 6ululea} e es awo ule}slssle 6u sanu el eo a �o aoslnaadns wei6oid a sem I senssl aoluas pule sao uas glim eoue jedxa Miom ana aojwwoo 10:luolsslu wot �pano siy }: .t u�a�q nog( pinonn qualp0IllaiS /s}see aj +04N1. '91!11 aolueVY pue JSIU90 J0}islA lewnpeled le aae}unloA `91 o3 -8 G03 aegwew aeo nvv `9 Goz -t, ! oe lee wew pjeog qn O spswoM awnlejed luesaid Z aa}}lwwoO AJoslnpy JOIUGS ewnIejed }o Alto ;sa }rap pun'PIaH 93111 /uoi}lso , <,.paCuOl�q -GA nog( y�lyN►.�l ua �rauoGi{� algp }upy� ao 31�i�:. Special Awards.0: 0-- grtifiotr Received Northern California Presbytirlin Homes and Services tar Award for outstanding work, ON. Please state reasons W iy,you want to be-cor 'me- a-mernbpr.of Phis Board,. CoMmission- or-C-6mrhiftee;-:in 'Juc�ing what specific 1. Objective you. Wouid be working`toward as d- :member -of fhts- ddvtsory:iavdy: i have enjoyed sere ng on t e Senior Advisory Committee for the past term, an I'd like to continue se► °ving and working Vvith fe ow committee members. Our main accomplishment has been the launch of the Ride program in collaboration with People People Services, in that they are providing program management. As our city population continues to age, l feel its vital to find ways we cart best serve seniors in our community. The Senior Advisory Committee serves as eyes and ears to assess senior needs and see If their are gaps that need to be addressed. Z LOZ ' l l aagn�00 pasina� a }ao e�nou6S'S,ur�oi�ddV: 11 ui sbuiuedo e9:4rwwoo Inoga peaj I ohs sigefi om_L •eowes Aw enui}uoo of 2jisep raw s,}► pus 9911!W WOO AJOSInpy JOIU8S 9qj uo 6ul/U airf . - - }uaua�(ojdua� juo� }nziup6ap'�a euapu aka }s asa _ d 'se}1 ON 32A :yo }isad -s►?�} o }pauiotido:. ud tfi s ro ai x ano:uiu�o a. ri u adr a M pia .n oossa nod GUO� }A�i�dda? An0A BUjMPjnaa ui lvouno� r(40- ay} o #:fin ;asn aq; p�nonn �aa} nofi rau} �ro� }auuo }ui .tarp }o=�uq a a- t} }:s� F_ p5_ L EV Cio:, o Petaluma E '.fPeta m,Ca#fo'rj!1'#a* Clty Board; Comi-nission. and %Committee Application. -- U G Clty.�Clbrk's Office.. -Z,S 5'& .1), E' e. CA` - - - cl I ty. @ petalumd' �Ierk. ci. ca.us ndlish� Stre' fi Pefalumci,,.. 94952.707. 778. 4360 E V Instructions: Use this form to apply to serve an any of the City of Petaluma, California's Boards, Commissions, or Committees.. Please fill out the Pori W < completely. If a question does not apply, type or write NIA in the space provided. When completed, please forward to the City Clerk's Office C!, 0" of Petaluma, I I English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. If you have questions about this form, plea? a call the City Clerk's Office at 707.778.4360 or e-mail us at cityclerk@cl.petaluma.ca.us. i a) Name:'.. :Ho me 4ddress City State,d' d Zi p, ,ode: Phone:" (If appainfed; do:you bnf thls--,-h'bmbei tobe-avallbblejo the,*,, -T (If 'fed, wa Mail' . -app6in .'d6.--you ntt6is address -tobe-ava'if*a'ble'to- bc the-pu J,c. pu .11 NO @. N. NO. (Cb Do yout* HYe: Wit i' n he Pe aluma. I Imi 'if -fbr: h ov long? YES ❑ NO z' e vd evm'Are you a registered '* t1 .-so, for ti"*16ng?-:-. YES ❑ NO 1 .11 Y4 :sP Do. PW 1 ),Plip H GOWQ/.0 -,aM;B.I.S..OAD4...no sa3lY'O`9Al P'913"APIPP , 8 ID44 9 . Luula'Aoln -s n o iAajd-: -A :91411,qor ff"W-RUMMS 191410 14314m-OS11,1saia iwwo:)jo'suoi sjwLu*6' ?sp**bdgA4 J , 10 jo SJDOA gs,*jsoaj,jo aq.jsntunot ee.Mguwo:)Ajospipv4ojuqs a4l.uO-am9s01:6 9N, Uo. emas -ol Buillim n -'aoio'4:3 4'sill.in6464 pb4moddo-jou 1 LU031:4 - p*`uoissiwwo:,) -Ipjoo . S.. :Isaialul jo. 6 . !w .'civic or Charitable Organization to: which -you =have:b elonged;.Tosition /Office Held; and. Dates: What*Special lriterests /Skills /fialeh s would: 6. bring to this'Board ,`Commission; or�Comrniifee? < College-,.Profess►ondl, Vocdtional.Schools.At dnded (Major Su6ject,.Ddtes,:Degree /Date): CC -:�(poq �Gos�npQ stt� . o �egwatiu.n sti p�nn+►o� 6u�j�o�n aq p!noni► noA seAu. .pejgo` ��Poe - s �nijni►_fu�pni�u� 'a a} iuiruo� �o uoisslwwo� 'p�nog sly} }o jagwaiu n :ataooaq :off �uonn nod( �(yM suosnaJ aM}s,asaa1d. - '. .pei��a�a�j uoi�iufoee� aospabMd jo�� ads.: Is there any otheHnformation`that you feel would be. useful #o the:City.Council in reviewing your application? Applicant's Signature Date Revised October 11, 2012 CA O D Q O N (-) O O 3 C a sa�a� CJ O ON ❑ Slk L6uol MoLf 1oj 'os }J f f; :nuUnln }ad uI Ja }on paaa4Si6ba n nOA- -bly '966 L gbnoayl tQ6 L woa j aaaq pesp. osla Ing `O I OZ eou1S ON saX L6uof MOLE 10j 'OS 11 L Ls #fLUCJ �t}fJ nLUnJn.Jad-aLJt�JLJ4iin anJj no�C oa ON � SAX (zollgnd aye Q QN $d.X. Q O� i9polloAO aq O4 SSaJppp'sjgy �uoM'noA Op <paluloddD li) :IioW "3 , a (zollgnd Z96t6 VO `emlelad , :apo� diz pun 91DI's:l-AR-D `ssa pp d aU40H i I H MJ31d " f V33 jONV :PLUDN- � -sn-oo•oulnlolad•l���alo�(�lo �o sn llou.l -a .l0 09St�'SLCLOL .lo aol��0 S��t�al� �ll� aye (loo �soald 'u.uo� siy�..lnogo suollsanb ahoy nog( �l ylouno� �#1� ayl �(q paMalAa.l alo suollbotlddb llb' ZSbt�b b'� 'ou.,nlo�ad '�aa�.ls ysil6u� l l 'ntun(al.ad �o 61!3 aoljlp 3,4jalD �l3 ay.l o� ploMloj asgaid 'palaldwoo uayM •paplAord aoods ayl. ul VIN a.ym jo ad /,.l 'Xiddo you saop uotlsanb o-ji �(la�aldurOo uro) ayl ono lly asoaid •saa44!w MoD jo 'SUOIS.3.lw , o3 'Spjooe S, oiwoljlr)D 'ownlop9,1 4O A113 ay.� jO Auc uo a u@3 O4 Aiddo o. w-jol Sly4 as-n :SUO1 Onigul s p� ptzanlp�ad-l���laal��(,.1� • 09Ei - 8LL'LOL • ZS6J'.6 b0 'Diunlalaa • '1aaa }S usilj.U� 'l L . s�sz '93go s� 813 X 'j!O s Board, Commission, or Committee, of Interest: Note: To serve on the Senior Advisory Committee, you must beat least 55 years of: age. If not appointed to your first choice, are you willing,to serve on other. City Boards, COmm1SSIOnS, or Commit#ees ?-if so,which? Senior Advisory Committee Yes, Parks, Peds and Bicycles.. Have you attended a meeting of this or. other City. bodies? Have you served on, i�terviewed,.or applied for this or other City bodies previously. Q YES F] NO F] YES Fn NO Present Employer: Behrens, Nelson & Knudson Law Office Job Title: Attorney Previous Governmental Bodies /Elective. Offices you have served, Position /Office Held and Dcstes: None 600 `aol000 slanr 'Mel Jo lootloS AIIsaaAlufl eaen eiueS 966 °usll6u�l `s}ad Jo JOPL10eg `9691100 slHIN S661 `9691loo aolunp eso-1 ejueS Z66 i, `ewoldlQ SH `100WS g61H pue tiejuauaalE] Ined GO luaouin 'IS :(91D,a /9al69a 'salba '4oalgnS JOfDW) papu94V slOOLIOS 1=011000A 'lpuolssa}Oad '9691100 -uollua}}e siflouno:D Flo aqj of asap} 6uuq pue sanssl aquas /4lluepi o} ssaooe aneq I Jell] an811aq pue `seaj4!w uoo pt-,,e spaeoq jo .aagwnu e uo pames eAeq I 'AIlI glss000e leolsAqd pue uoljeliodsueg a�ll sooi/uas aquas 6ulssaappe pue `Aglleau PUP- aAIJOe 6uiAejs `aouapuadopul of sawoo j1 uegm op sluello Aw sanssl oases E)ql ;o Auew ooe} Aaqj pue `saoluas aae `ewnleIad ul aAII gloq oLIM `s}uaaed AN 'S100 aoj saxoq pooh. 6uu9A1lap pue `aa4ua0 sooimoS aldoad ewnlejad uj1M Ajloedeo Aw ul saoluas ujIM aaalunlOA 1 `AIleuoljlppy -ssauilauol pue Ain(ul `pneaj woaj siapla esogj loaloid of 6uldlau pue `sanssl aapla ullM 6ulleap saagwE)w AIlwej lslsse osle 1 *AglleE)q pue }uapuadapui Aels of 6uluueld ul saoluas jo spaau eqj 6ulssaappe uo aol}oeid Aw snool I `fluleW •uoljeloossy aeg emopleo eqj Aq Mel Isms pue `5uluueld alelsEl `a}egoad u! Isllmods e se paljll-loo 6ulaq }o ss000id aqj ul osle use 1 •sanssl Aj!oedeoui pue dlysaoje/uasuoo pue `sanssl jpuaq ollgnd pue leo -ipoN `s}sna} pue slllM uo sialuao aollowd luaaano AN *spleu Mel aaple pue `digsaoje/u9suoo `salelse ul 6ul�aoM eouataadxa saeaf uaJ aaAO ql!m Rauaol4e 6uluueld ajelso ue use I &a9l4jLULUo:D ao 'uolsslWWO:) 'pJpog slgj of 6Uliq nog( pinonn sju9lpj/sjjpjS /s4saialul IplOadS 4DLIAA -aa ;ua0 s4av ewnla }ad pue `fuejgl-j ewnlejad `aajua0 :4ea0 dews ewnlelad `ialeagj jegeuu!0 `S:L00 :aaajunlon'(060Z souls) aee elluodile0 jo uogoeS safe ;s:; � s ;snai `(60OZ souls) sAauao4.y Me-1 aapl31O 1(uaapeOy leuolleN ,(0�OZ aouls) gnlo s,uewoM ewnie1ad :aagw @N quesaid of 6 �OZ aunp •alegb -o0 `dnoa0 6uluueld 81e4sE] ewnle ;ad -papeau se;uesaid o} 60OZ aunp `gn10 6u!MO�J Aea 4PON `llouno0 fuoslApy queseld o} L bOZ Ae1N •4snay pueq eWOUOS `aapea -1 Bulao4luOW IuauaaseE] uolle/uesuo0 .g 60Z io sselo ewnle }ad digsaapee� • ;uesaad of 0 Z0Z aagweoap •gnlo fuelo�j esuunS ewnle ;ad `saoloaalp jo ping 10 aaqWaw '(weal aeaA 9) juasaid of 1 bOZ eunp •aajua0 soolmaS aldoad ownleled `sioloaala jo pime jo aagw@N :sa.lpa pup `pieH aol}l0 /uolPsod'paBuolaq aADLl noA q:)iLiM Ol uoi4Dziup6.10 algD llpllZ) io OIAI0 Special Awards or Recognition Received: San Mateo Women in Law Scholar, work for Legal Aid senior conservatorships. PEF Dorothy Weller Scholar. Please state reasons why you-want to become a.member of.th "is Board, Commission or Committee, including what specific objectives you would b.e working.toward as a member of this advisory body: I wish to be a member of this committee so that seniors in Petaluma who do not have access, transportation, or a voice, can be represented in terms of city planning, mobility, and senior activities. I do not have specific objectives, rather, I intend to work with seniors in our community to address their needs and concerns instead of projecting an agenda onto them. I communicate often with seniors in my legal profession, board service, and volunteer work, and hope to learn from them how the City can better represent them. Z LOZ 'L L aagopo pasina� S// S� 9 I-, a Da aan }ciu6is si }un)iiddv juawaounouue jadadsmau japnoo sn6jd �6uivado MR }nogD aDaq nod PIP nnoH ON 91), .1 aq no� p1noM Lsas!JD oi}UOO D Mons }r 6UI40A-U0.1} uid}sgD o} 6ul • }saaa}ui }o }oii }uoo iDi}ua}od D s}sixe aaai{} aaai4m saa}}DUa uo a }on of }ou saagwaw Apoq A.losinpD `pa}uioddo llo. s}oomp Aoiiod A}i: fuejo�j asijuns e'wnEalad `JGIUGO saoanaaS ajdoad ewnlalad :4u9wAoidwa /uoi}DziuD6ap - }o aLuDU a }D }s asr)aid 's9y(11 ON F-I S3), FMI l.uoi}isod sir}} o} pa}uioddD }l •Sai }np UQ u }i1 p}DjnoA 6u1LU1oped Ui }saaaYUi jo iali}uoo D poweep aq 41461w }Dq} }uaLLUoidu g /uoi}DZI ICD ossq, no/( a.td -uoppuE)wwooaj jo sial4al pue `uoi}eoiidde siu} q inn Iiounoo A}io o} 19}}91 e Guisoloua we I guoi}DoiiddD anon( 6uimainaa ui llouno:) A4i0 aq} o} injasn aq pinorn ioa} noA }Dq} uoi}DLUao}ui 19L140* AuD ajaq} si 0 N r. 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O Q o -. fX1 ro �E O c O �, m �, �, O C/) .,'�.., . ?. � •w .o c . - ° C a ° as o a m� of d,a v ° o. � CD H am: y . .Li N a. O 8 off: �. v. 0 CL a s U .: z 0 I I CL Q O U O m m LO `® 1 001� City of Petaluma California JUN. 08 2015 ;. City Board, Commission and Committee Application CITY C.LER� >- E City. Clerk's Office a U 11 English Street .• Petaluma, CA 94952.707.778:4360 o cityclerk @ci.petdluma.ca.us o O vi Instructions: Use this form to apply to serve on any of the City of Petaluma, California's Boards, Commissions, or Committees. Please fill out the foi N > completely. If a question does not apply, type or write NIA In the space provided. When completed, please forward to the City Clerk's Office C Q of Petaluma, I 1 English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. If you have questions about this form, plea L call the City Clerk's Office at 707.778.4360 or e-mail us at citycierk@cl.petaluma.ca.us. 0 .a =Name: i N Wayne M Wilson Horne Address, City, State and Zip Coder Petaluma, California 94952 Phone: (1f appointed, do.you want'this number to be-avalloble to the public ?) YES ' M NO 6 'P you live within the Petaluma City limits? 0 YES ❑ NO re you c registered: voter in Petaluma ?. RYES 1-1 NO E -Mail: (if appointed, do you want this.address to be available to the public ?) ❑ YES 50-1 NO so,.for how. long? ;if so, for how.long? 35 years 35 years 6odrd, Commission, or Committee, of Interest: If not appointed to your first choice, are you willing to serve on Note: To serve on the Senior Advisory Committee, you must be of least 55 years of other City Boards, Commissions, or Committees? Ifso.which? aye Senior Advisory Committee Tree Advisory committee Note: I currently serve on the Committee. My appointment expires 61 30/15- This is a request for reappointment consideration. Have you attended a meeting of this or other. City bodies? Have you served on, Interviewed,. or appiied.for this or other City bodies previously? . W YES ❑ NO 0 YES ❑ NO Present Employer. Retired from State of California government service - 36 years Retired from Federal government service - 21 years Job Title: - State of California - Last position held: Regional Manager, CDSS /CCLD /Senior Care Licensing Program Federal Government - Last position held: Regional Inspector General, DHHS /Regions IX and X Previous Governmental Bodies /Elective Offices you. have served, Position /Office Held and .Dates: State of California -2008-10 Consultant to implement legislation to reform residential care for children and youth. State of California - 1987 -08 Positions for the Community Care Licensing Division /Dept. of Social Services e.g. 2004 -08 Regional Manager for the Senior Care Program. Five offices serving 31 counties for licensing, inspections, complaint investigations and administrative actions of licensed Assisted Living Facilities. Department of Health and Human Services: 1969 -74 Washington D,C. (see attached resume for specific positions). 1974 -87 Region IX San Francisco and Region X Seattle (see resume) 99a6ep �joM pooS p ja}seVq - e� seag9N ;o �4!saaAiun ale04P90 alanpejJ 996E - ue4n jo fi4lSJeA!un waA60101 g :(a Dp/eaaBap 'sajoG '4oa(gns loft)W) papuiDIN MOO OS 1Ouoj1D3OA'IDUO1ssaJOAd 'a6apo:D pepuelxa djysjagwaw aa}}jwwoo Aaosjnpyjojues Aw eneg o} }senbei Aw 'aouaH °sanssj esegj o} e}ngjjluoo of uotljsod japaq a uj ew seoejd e.msodxe anoge ay} anajjaq j •angelueseidej juawdojanea A4junwwoo pue 6ujsnoH Aunoo ewouoS pue jo;eup000 6uisnoH ewnjejed ay} q }inn s6upew pue suoj }ea}jgae joi}uoo juai pepnjouj sigl °6ujsnoy 6uisseippe s6upeew pue sdoysAjonA'swLio; se ijam se uolplueseid juewejd 6ujsnoH ag} papuepe aneq j °(A}jo ino uj ,AA-d„ uanas eql uj pejuai seoeds 006 Apeau ay} jo O0£ MOge) aagwnu pe}jwjj a Aluo of ajgeipene sj aoueujpao joiluoo Zuea eqj_ - seojloerd pue suoj ;jpuoo �aed elpow uaeq sey }seiejuj iejoeds ANN •eouejsjsse 6uisnoy g uojpas jdeme o} sia}uea awns Aq eouepnjax e - A}jjgjsaooe (g) pue 'uojt.ejndod 6ujnnoa6 a o} }eeJq} buiseaaouj - At.jjjgeploge (Z) ' %Z ueyj ssej - Ajjjjgejjene (L) euem sanssj Ae� eqj •6ujsnoy ;o me aqj uj seen 3uawan(onuj joaajp Aw a}}jwwoo Aaosinpy Jojues eqj uo djgsaagwew jue uno Aw 6upnp 'GRO q}jeaH jeaqj pue bujwwea6oid aatuao JojueS 'suoj}ezleu6JO aoueu;91UP VY yt.jeaH 'pjeoj1)GA pue aJeojpaW se Bons seers uj uogejndod fuepja eqj 6ujnjonu1 suoj}oedsuj pue sajpn }s jeuojleu pepnpuoo j juawwanob jeaepaS eqj gjlm suoj jsod Aw uj •Aaanjjap aojnes jenpe uo 6upedw► seoj}oeid pue sanssj eqj uo eAlpedsied a papjno.id seq sjgs •sdnoj6 Apnwwoo pue sieptAoid eowas `suoj} me6jo'sajoue6e eqj qpm uopiogejjoo pannbei uojssjw mo aAepoe of •uoj;ejndod Aaepje peeu -uj eqj jo 6utaq jjann pue Ajejes 'gjjeeg ay} aol ejgtsuodsei seojnaes pue swej6oad 'sajoijod eqj uj panjonuj Apoeip aweoaq j sajIllpe; ejeo joiues pesueoil to luaweoic�ue Aaoleln6ej eql job. je6euL-A jeuoiBe�j ele }s a se 6ujnles ajrgM L9044jLUWOO ao- 'uojssiwtxio:D. 'PJDOS s141 off, Sujaq nog( pjnoM sivaioi/sjns /s}saaam j®joads INK, 90 -`,OOZ joint - fiGn>r pueJE) I!Ajo ewouoS jo �4unoo £ti-ZLOZ aagweVq �jnpd - aajjjwwoO fijosIApy ujnoA ewn1e 19d ;0 40 9L-£ LOZ aagwaVM - aa:}iwwoo fijosiApy aoivaS ewn(elad 40 40 :saID® puD 'pjaH aoiJIO /UOj}jsOd 'Pa6UOjag aAD4 noA 4?i4m of uoj4ozjuDSjo ajgojIjD4:0 Y0 -JJAI:) ll� Special.Awatds or Recognition Received: Examples: World Health Fellowship (Europe) Federal - National Leadership Award, National Certificate of recognition (Office of the Inspector General) State - Governor's Award of )Merit, Distinguished and Outstanding Employee Awards Please stcte.reasons why. you -want to become .a member of this Board, Commission or Committee, including what, specific objectives you would - beworkingJoward as a member of this advisory body; As described above. n Z l0. ` l l Jac{o j?p pasina�j a }pa. ain}oufilS s,;uoollddv japnoo snbjV pue Builsod liounoo Al!o �6utuado sty} 4nogo may noA pip moH ON S�J Lsasljo }all;uoo o vans11.6ul}on.woj; ulo}sgo o} 6ullllM eq noA pinoM.: •}seia}ul ;o }all;uoa Iol}ua}od o s}stxa atay} alayM saa}}ow uo a}oA o} }ou saagweLu Apoq Ajoslnpo,,pa}uloddo llo s}oejlp.Aollod 8413 :4uaw,(oldw3 /uol}ozluo6jo ;o atunu a }o}s asoold'seA ;l ON © SSA ;.uol}lsod sly} o} pa4utoddp,. 11 sel}np anoA 6uluaaoped ul }se;aiul ;o 4011;u00 o powaap aq ¢461w }py} }uauyAoldw3 /uoll<ozluo6ao-.Au. y}lm pa}oloossa noA *99:4iwwoO AJostnpy JatuaS aql ut dtgsaagwew anut ;uoo o} paaouoq eq pinom I -aa;;twwoo kostnpy jotueS eq} pue uotssiwoo kostnpd glnoA Allo eqj `Aanr pueaE) fi4unoo eqj uo uot}edtotlaed Aw gbnojq} Ju9wuJ9no6 A }lo pue �4unoo ;o sseuaaeme 6utule6 we I •swei6oid pue Aoilod leloos uo ant}oadejed pepuedxe ue qj!M aw aptnoid }eq} stanal Ieaapa; pue eje }s ay} uo aouataadxa aneq op I l,uol}oallddo jnoA 6ulmalAaa.ul llounoZ) /40 041 o} in ;asn aq pinom pa; noA }oy }.uot}pwao;ul jay }o A66 W94 s1 IT? IrA 0 fo cm o 00 0,,3 a " C3 kc� 65. 2 Z C3) C4 tz M.-C 0 (10 cg LL W, x 03 z 0 em oo 03 r- a) Wo En c r- - fix me.) m C cp 9L —in c —2 'o .0 0 0 4 X- -01 L -0 0 a): r q as � t RMI Eli C M 156)1 =10 QUO Bw IL � el, w toe 9 10 at, '0 CS 0 W E M-0 z 41 ck� ).Zk 5 d OZ Qj tip cp e CY, .0 m 8 E —.0 ap z .Coo gg 41 ck� ).Zk 5 d OZ Qj tip cp e CY, .0 m 8 E —.0 ap gg LM 23 Vol:o 0 fz r- 0 M .E .Q E Xw 0 U N E o 0 Q > V rl `a , N CP L O � C S �U u H � m m L f^ RECEIVED i a "a� a E �E U U :) O N LC M Q O1 O O C s U a� JUN 4 8 2015 1 City of Petaluma, California J�" City Board, Commission and Committee Application CITY CLERK City C le rk's Office 1 11 E nglish Street • Peta luma, CA 94952 . 707.778.4360 • c ityc lerlc Lp eta luma .ca .us i Instructions: Use thisfbrm to apply to serve on any of the City of Petaluma, CaliforYlla'S Boa rds, Commissions, orCommittees. Please fill outthe form completely. If a question does not apply, type orwrite N/A in the space provided. When completed, please forward to the City Cleric's Office Cityl of Petaluma, 11 English Street, Petaluma, CA 94952. All a pplications are reviewed bythe City Council. If you have questions aboutthisform, please call the City Clerk's Office at 707.778.4360 ore -mail us at cityclerlc@cl.petaluma.ca.us, Name: j Miranda Bucy I Home Address, City, State and 21p Code: Petaluma, CA 94954 Phone: (If appointed, do you want this numberto, be available to the public?) E- Mail: (If a ppo inted, do yo u wa nt this add ress to be ava iia ble to El YES 0 NO the public ?) 1-1 YES NO Do you -five within the PL-taluma City limit? If so, for how long? YES ❑ NO 3 years Are you a registered vOterin Petaluma? If so, for how long? M YES ❑ N0 3 years "a� a E �E U U :) O N LC M Q O1 O O C s U a� Board, Commission, orCommiftee, of Interest: Note: To serve on the SeniorAdvisory CommWee, you must be at [east 55 years of age. If not a ppointed tx) your first cholce, ate you willing to serve on otherCity Boards, Commissions, orComm "ttees? If so which? Technology Advisory Committee no Have you attended a meeting otthis orotherCiiy bodies? Have you served on, interviewed., or applied forthis or other City bodies pieviously? El YES F-01 NO ❑YES Fn NO Present Employer. Google Inc J ob True: Account Manager Previous Governmental Bodies Sective Offices you have served, Position/Office Held and Dates. NA (AbololooS -q wslleuanor) ,90 ye uoslpeW - UISUOOSIM JO AI!Saanlun r(a4ea/oar6aa Is%ea l�:)afgngaofeW) papuiTaVslooyx leuo .4e :)OA'leuocssalOJd'a6apo:) sanplilul AbolouyOel alegj uo salOua6e weWUaan05 y }inn 6u1 aom aouaiaadxa jo saeGA leaanas pue Af)'OlouyOel ul 6uNaonn Alluenno zaap�wwo:)ao'uoissiwwo:)'pxeoasitA ot.fuuq nog( pinoms}ualeiLMIpiSf w l le1�adS eyM `dN a4e7 pue `plal -t a:)t,4O/uo>qsad `paGuolaq aney nor(y:).4m c4 uoq.nzluaft0 alge eye ao �vu� V" °W. Special Awards orRecognMon Received: NA Please state reasons why youwantto become a member of this Boa rd, Commission orCommrtbee, including what spec Mc objectivesyou would be working toward as a memberof this advisory body: I'm passionate about helping Petaluma with any technology directives that help to make the city a safer, friendlier, and more innovative city. I'm hopeful that my experience with government and technology can help to make this process easier. ZTOZ.`TTaago4:)p pasina'd 9 W?I/ V9 — f�n8 �pu�aiW area aiMeuBIS s;ue:)tlddV salepdn aalipwoo auj jo .Au -ew of aq!aosgns 1 - aab -eu -eA Is11 46uivado sitp.4nogeaeay noA pip moH. ON 7 S3,k Fm- 1 isesue :t:)illuo:) a 4ons:i 6ugon tua4 uielsge % 6uipw► aq noA pInopA ISW%uiJo:t:)illuo:) Iequa4od a sgsixe aiat# aiat. msianew uo a %oA agou siagtuaui Apoq Ajosinpe'paiuiodde lie siawip Aailod 4:) dN quasi AoldLu3/uoq,eziue6uo jo auxeu %qs aseeld'saAdl ON Slk E] zuogsod siLA 04 paquiodde ji sagnpinoA 6uluuopad ui:paiaquljo:t:)illuo:) a patuaap ag446 Iua:te4 .4uauiAoldLu3/uoq.eziuerwo Aue tpinr► pe4ei:)osse noA ate/ dN juoq.em ddeanoA 6uimainai ui ll:)uno:) atla. o4It4asn aq pinom laa} noA:,eLg uo,4euuc4uljatpo Aue aimgsl U O C Q n Q n F N --ti O -c N Q -c 3 N m X t� o• W 0 v -�e Q y D y� l ! 0 3 N fD r� n Q N 0 sieeA CZ I ON F-1 SD�l 0 1fiu01 Moy Jol'os 111 gdwnp0d ul a840A p9J94sl6a' o noA a.ty sleaA CZ I , ON F-] S3A o I 15uol Moy aol'os 11- j isllunl ARZ) aulnlp49d 0144 UILHI n aril noA oa ON F* SdA F-] (2otlgnd ayj ON F SRA 01 a1g01.t0n0 aq o. ssaipp0 vt44 . uom nog( op pajutodd0 jl) :IIDW -3 (ZOggnd atai o� alg01r0n0 aq of jagwnu stye 4uom nog( op 'palutodd0 jj) :auoyd 1 ' i Z56tb6 VO `ewnlelOd :apoO dIZ puD a4D4S IA4j O 'ssa.tppy awoH N 4. :at,uoN D CL sn*0o-0wnp�ad-to @)ltaloAjt3 10 sn Itaw -a 10 090p'8LL"ZOL 10 a3ldjo Ito ayj 1103 N• bald 'w.tol stye �nog0 suotlsanb an0y not jl •ltduno.3 1413 aLg Aq paMarnaa at0 suogoijilddo lid -2S(5k6 do 'ownlojad 'taails ystlbug 11 '0wnl0�ad 4o 0 p aoyjo s,4jalo (.Ito aq� of ptorjoj asoald 'pa�aldwoo uaLIM •paptnord goods aql ut VIN a.l1jm .to adXj 'XlddID .Iou saop uogs -Gnb 0 41 -XIalaldwo3 < m of awl no lltd amald -saagwwoo to 'suoisslwwoo 'sproog s,0(woploo '0wn10�ad jo /410 ay1. jo Auo uo an-ias of Alddo o� wJOj sryl asq :suolpaigul o O 3 i 3 ' sn•po*DwnjD�ad*lol]jaajoAjlo • 09£l'8LL'L0L • Z;306 bO 'Dump }ad . �aa43 Us!Il5uD L L $�sz- a � Allo ao!�;O s3�laaJo Alio (D Q uoi}ootlddv aa}INU woO puo uolsslw!!joO 'pjaog AIIO Board, Commission, or Committee, of Interest: Note: 7o serve on the Senior Advisory Committee, you must beat least 55 years of age. if not appointed to your first choice, are you willing to serve on other City Boards, Commissions, or Committees? If so which? T.A.C. no Have you attended a meeting of this or other City bodies? Have you served on, interviewed, or applied for this or other City bodies previously? YES ❑ NO 50-1 YES ❑ NO Present Employer. Petaluma Transit Job Title: Paratransit driver. Previous Governmental Bodies /Elective Offices you have served, Position /Office Held and Dates: T.A.C. member since 2013 Agdej6oaE) Ul Vo -Vd �O fl4lsJanlun apinsaalliW :(alga /aaj5aa 'sa4no 'pa(gnS jo[oW) papu941y S1OOyOS leuOIIDDGA'lnuolss9JOad '950110:) •saoaA V Job. Janiap 11sueilejed o pue l.ueplsa t awl} 6uo-1 1904AWWOO JO 'UOISSIWWO:D 'pagOS SIL14 O} 5uliq nog( pinoM s+ualnl /SI1PIS /s.lsaa94ul lnlOadS 4DLIM ewnlolad aeglabol 6ulplmga�j :sa4ga pun 'p19H aO1:90/uol4isOd 'pa5uolaq army nog( yOlilm 04 u011nzlun5ap algn,ltanil: JO OIA10 Special Awards or Recognition Received: Certificate of Excellence for safety and customer service. Petaluma Transit 2015. Please state reasons why you want to become a member of this Board, Commission or Committee, including what specific objectives you would be working toward as a member of this advisory body: I want to continue serving my adopted city that I have truly grown to love. ul Z I OZ 'L L aagopo pasinaN 91 OZ /t' /9 uwna3 euen alga 9an4DuBis s,;ur,oiiddy 'o.,yj aul .uo 5ui/ues Alluaimc) lBuivado sig4 }nogn anaq noA pip mOH ON S3)1 Lsasiao 131i;u03 a Lions 11 6ui }0n uaoaj uia}sgn oi. 6ugpnn aq noA pinoM • M91ui 10 .iatiJuoo 1pilue4od D sisixe aaag4 aaagm sja}ir)w uo 910A ai jou saagwaul Apoq AjOSiApp 'pe4uioddq iip spaaip Aoiiod AII:D :ju9LuAoidW3 /u0ijgziuo6a0 Jo aLuDu 94e1s asoaid 'say(1i ON FMJ S1), n Lu0i41sod siy} o} pa.iuiodda p sa�np tnoA 6uuaaoped ui isaia}ui jo 4oiijuoo D paLueap aq {g6iw }ny4 }ua�u(oidua3 /uoi4DziuDBjo (uD Lipm pappossr) noC aay i •I.iunwwoo Aw ames o} Ouidieq awi; AW paAo(ua aneq i -O•d-1 eqj of aaIngialuoo purr eouesaid e1geiiea e ueaq aneq i Zuo►�poiiddq ano�t 6uinnainal ui iiouno� � ay.i 04 in}asn aq pinom 1991 nog( }pqI uoi�DLw0Jui aaq }o �(un aa944 s, �La I o. Pat za;:Calf�a: City �`o "'ar1;:Gorrirnissian;iicl .Co,iYrrrriitee:Ap . dcaf:iart 201 i •r •1 CLERK. id ' • . E ai• Instructions: Use this form to apply to serve on any of the City of Petaluma, California's Boards, Commissions, or Committees. Please fill out the f� -C completely. If a question does not apply, type or write N/A in the space provided. When completed, please forward to the City Clerk's Office I of Pe luma, 11 English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. If you have questions about this form, plE tle 707.778.4360 @ci.petaluma.ca.us. p call City Clerk's Office at or e -mail us at cityclerk Home.Address; City, Stafe:.ar d: Zip.:Cod'e,: . I Phbne: (if appointed, do you wsant`fiI its nUmb'er to,be available to -the i a public. ) E -Mai[: (If appointed, do, this address to be available to ❑..;YES.: iV;.0 the the public ?) ❑`' Y'ES.' ff.NO t 1 i E - %•:..''. D'ot" lie wEfhm tta'e..P:'etatuma'C.i limits. y ::1f YES ❑ NO / - Are.j�nu :64eg. ester •:e -d;;vofer;'in ='PefaGut ap? if s6Y:foi hovi I'oatq: ?' ` YES ❑ NO E 0 U 0 Q i _ /YV f _ • 'Y.' '{:• �� �•�� •! •�'+J .: 1 is •:•�,t Q `•an'• �•�.�. . � sa,�,, q•;P ..?�- •pl•.?�� a,.z.3#Q,/:Uo�} sod . an�as.a�q t�oiC :�.a�� O ^a�n►��a l.,a ?p' ..a�Ib uau�.u��.. ' o• :sn.. nay o%/ a�'��aa ON 0 SRA ONE] SR j 1 .:. ... ... . t. . :. ... .. .jj� _ _ - •.tea ^O ` - ' f.:'� . . � •4 hT!:.•,.' •.eFJ.yf.. .�i�. sal oa: o:aoa, ,= o °ur ui" } ?, - �`i = aay }o J.0 •sre�4; aoj pa[[ddb'aopa�naiva:Iui .uoanias 1 lLI.-,)jqAk-0t saa Iuawo 10 'suo[ssjW,iu•o, 'l ano, X i• as o j "`'' r `aa 1 • a6o ' uo antas o 6irj[[[M no�(aan 'ao1oy0 :40IJ anOA:q� palu[oddo }ou 41- �o'voai( .g poaj 4o aq 4snw no�i 41W . of >(iosrnp�y ao(uaS :ay; uo -anus O.L. :}sacra }u'[ 1b''.aa;}�iu�`uao� �o 'uo[sstuauaoO ' 1008 70 Oates: MV0 . 'p�oY�i�.s �i1/ a� �� �2�2 IS,.ogl l�v1201 :727 t-O eae., P ro Fes t,!*iD,h",bl..,,.,.,V,*� `:cdto.h'6*1.S JA P �,q p ttt Y. m! q M - AV Rev5e-d fibbr 11, 2012 i T m..dt i t�-Ahf 1641.1 A f-In. P-* r#t -c YES NO If'•yesl -please-stofe name of-.0rga-hizatioh/EMp:loy.menf: , Q.- t - ci, dlte-.ots� all...-Cl •' fed body� m eni-b*�vh.of. to,.v,df,6 on Mcjffj�rs- re� ''tts ittl conflict -6f ltit.erdst. e xi -.a potent Old'vd-b"bb.-Willing to: Fr jtf+'ariset?. 0-YES El NO 6-*=' h ei- d''r, b n P s J n q:ure Rev5e-d fibbr 11, 2012 i ti ` O N E_ S�,l nn04. ao'} 'os'� . :�bcz�i�AEa•d .ut;aa'�on;paaa�St6ea, p .no aay ON SaA �6uo�.nnoy ao.} `os �1 s�iiu> !� ,p,�nlppad. -ayl uiy}im anal n A od El 04 a grpno a .o ss-w o sr uon�.noi(.0 a ur ddx� :'ip la �. a . pt? , .ill p p l',Q 0... I. V11 a�l� a! >jiit?i�b'a .:o .taq uoy :epoo diZ :pup•ojDjs'Aljb'ssaappy'wo.H eM 31 Z5 1 it o •� LQZ T7 :ai.upN �- ?� •sn-oo-ownplad•10 @4lalo/�10 1p sn (loos• -a jo p9Et,'8LCLOL 4o acgio 3,4jat3 Avo 44 Iloo n' 0 bald ' j o anb anoy noX 41 •llounoD x(13 ayl Aq panaalnal wo suoiloollddo llb' 'ZS6k6 b3 'ownlolad 'laa�lS �lsJbu3 It 'ownlo6j 40 0 N p 00140 3, )f.ra13 43 ayl of p-jom.lo4 asoald 'palaldwoo uaLjM aoods aul ur YIN alum Jo adAl A/ddo lou saop uollsanb o jl *Ajalaldwoo lol ayl lno Illl asoald •saagwwoo .to 'suolsvwwoJ 'spjoog 3,olwo4lloD 'ownpola f jo Allo ayl jo Auo uo anus of A/ddo of wjoj slut ash :suorl l wul n` Q sn^ao-awnloladio.9�aalaAlj: e 09et'e/f /01.! ZS6t6 Vb lownlo}ed o laaal'S gsjlBud L � a01 W O S,�J, 10, uoljP: ?ijdel`g'-aa#jwui.00 pun ,u,ojssju!zuo�) 'p.1pog X410 Bogr Note:' aqe: 1, Commission; or.:Comm'iitee, of Interest: oaerve on.the:Senror Advlsory;rComm ttee,;you must beat least SS years:ot If not appointed .0 your first''choice, are you willing to serve on other City Boards ,.Commissions, or Committees? If so which? "77-A H_ave.,you•attende:d a:meeting_of.: is-'or otherCify:bodles? :. :....,. :..:Cityl`b Have you served .on, interviewed; or applied .for this or other e-t- - Vlously.. L`_I YES a NO I�!I YES ❑ NO Present Erriptayer:. :Job T� le: Previous Governmental °Bodiies %Elective-Offices you. have served,. Position /Office Field and Dates: - *' OA :.(a }pq /ea�6ao `sa�oQ' oaignS:ao(p,{N) Papua�{�/ sjooy S,Couor }000 '�quoissa oaa !a6a�jo0: Special Awaids;or Recogn,ifiiot. iZeceived: . I S 944 �d"C � � � � °� 0 ��1� ��� IO '✓r��,Q.r �"'�r �%�I � 1 / � ' ` V'♦/ a✓ 1 Riease: sfidte season's <iwhy yov::vi[cini'to ` b ;eco.rne ,d: rr e'm ei :of.ftiis'B.`dard Cotnitiissio,rr or::Comriiiif:e in J di what s ec�fic :... :..: .. P . o bje cfinresyqurwou[d be;working toward'as a member - . of fhis" disory fody`- Q Z LOZ 'L t jego4z)p pasinaN r a}a,d • 9.in4au61S s;}uD :)ruddy 1 c.. . o nD. o p'nnoy; .. e _y:p: ON ® S3), i 'SOS] ,1 }: u.. '.:s: }t- 6iiiouio� tatblsgs,. o} BullliM;acl n,o�t,p�lnojVj:: • }sa ..40tj}u0o,lgt4ua4od b s}sixa.,aaaq} aaaynn saa}Iqut uo :a }on o} you saaq�uaw•.�(poq �(aostnpn `pa }woddb:tjb >S }oa�tp �(otto ,:i(ji� •. o u► of 'iu� .i� ` o u:i d• �(�. • .. - .... �uaii:t( •.1 :c1 �� :u,, ., }p2 a6 .p�} . p } . }. 1 • ON Om S��l Clo[VSOd Sty} .O} pa�Ul dclp P.sat}np,•aii.oiC Siijurao} tad ui saga }u b; }dtt }uo� p patueap acj. }y6�ua }oy :luaua�(oldua�. %uol}azt -tai 0 — 'ktin -q1! n pa}ni?o'ssp ::no ,.aav uol }ao►lddb jnoA.:6. tlnnatnaa u► ;jiouno:) �( }lo ay} ol•tn ;asn: aq.ptn.onn:taa }nor( qyI uot}bu�1o}ut'.aa., 4.( ub away }:sj ,yU 0 0 1E' S Q3 N 0 E H O o Uaa s� v o •CL Q Q 4s >s N 'U v U `v y LI., %0 A— a M 1�O M 'O. � O • N X O Q1 N � A E N 'a A =, N 0 N � a U � o O U U 9 O >✓ A U O c U- v U N C w e l � ;a s City of f Petaluma, California JUN ® 4 2015 City Board, Commission and Committee Application City Clerk's Office CITY CLERK! 11 English Street • Petaluma, CA 94952 9 707-778.4360 • cityclerk @ci.petaluma. ; Instructions: Use this form to apply to serve on any of the City of Petaluma, California's Boards, Commissions, or Committees. Please fill out the ij completely. If a question does not apply, type or write N/A in the space provided. When completed, please forward to the City Clerk's Office'. of Petaluma, I I English Street, Petaluma, CA 94952. All applications are reviewed by the City Council. If you have questions about this form, pie call the City Clerk's Office at 707.778.4360 or e -mail us at cityclerk @ci.petaluma.ca.us. Name: ar Home Address, City, State and Tip Code: � Q3 cv vE cn O .0 L O :n Uv Q N O F- Petaluma, CA 94952 -4206 Phone: (If appointed, do you want this number to be available to the public ?) ® YES ® NO E -Mail: (If appointed, do you want this address to be available to the public ?) ® YES ® NO D.o you live within the Petaluma City limits? If so, for how long? ® YES ® NO 2 1/2 years Are you a registered voter in Petaluma? If so, for how long? ® YES ® NO 2 years Board, Commission, or Committee, of Interest: Note: To serve on the Senior Advisory Committee, you must beat least 55 years of age. If not appointed to your first choice, are yov willing to serve on other City Boards, Commissions, or Committees? If so which? Trees Perhaps, Youth Have you attended a meeting of this or other City bodies? Have you served on, interviewed, or applied for this or other City bodies previously? ® YES ® NO ® YES ® NO Present Employer: Retired Job Title: Elementary school teacher, retired Previous Governmental Bodies /Elective Offices you have served, Position /Office Held and Dates: NA SL6 L `uopleonp3 ui aleoplp eo alenpeag- }sod u! (Nn) uopuo-1 10 Aj!sIanpun agj WOJI (Jualenpnb3) -y•W OL6L `/�!sJanluo eue!pul woaj aanpeiajl- an11eaedwoo pue uewjeE) u! ,V.8 algnoa :(9}od /99159a 's94oQ '4oa[gnS .wfDW) p9pu944t/ slooyoS IDUO14DDOA 'louotssa}oad '95911oZ) a1ep of iel os aalem jo suolleb jo spaipunq Auew panes `Alleopioagj `pue Ajunoo euaouos u! saouap!saI 009 Iano pa}!spn anew sluellnsuoo asuaS uapieg inp -adeospuel asn aapem mol e aleaao of moq uo as!npe of `lsenbaa uodn `slueppsaa fqunoo J!s!n pinoo I Iegl os sl!Ns uo!peb!aap pue Ixouan gla aapem uo Aoueby ia}eM Ajunoo ewouoS eqj Aq poupeal. seen I ` /asuaS— uapaeE)/aajseA asuaS uapneg /6wos /saj!s /npa•jueon / /:djju weiboid asuaS uapieg ,siauapieg aa}seA fqunoo ewouoS eqj ui juellnsuoo e sy •saaal 4o „sia� ons„ 6UInOWGA jo aoueliodual aqj pup :saaaI a�ogs jeu} „slow 6u11pa16„ anouaaa 01 MOq 'Agjleaq Aels Aagl ainsui of saaal aunid of moq :aoeld lgbpa aqj iol jueld ao Gail Joaaaoo aql asoogo of moq 6ulpnloup `o!lgnd eqj gjIM seaal aol uo!ssed Aw aiegs o} Aa6ea we l -saga} Aglleaq uplupew of moq buppnloup `pliom jueld agj jo spaau eqj jo Auew jo alge6pejmoux we l `fi4unoo ewouoS ui pue puejAieW gloq ui aauapae!D aalseA e sy 0941) WOO ao 'uorssiwwo:) 'padog si44 04 5upq nog( pinom s4u9lelJsllPIS /s4s9aa+ul IoloadS 4ayM t LOZ u! s}oy Al!et] g6nojgj asjnoo aanjlnoewAed e pajaldwoo `aosuodS ,s}oy AjjsCj -1, LOZ `aal.!wwoo goeaa}np iqlunwwoo eqj jo alego -oo `aagweA paeog empejad jo AAnvv uaooasselO aq; ul uae1601d uo!leonp3 `eoue!llV puellaM ewnlelad 9 LOZ Amnuep `aapea-i eaay Ajunoo gjnoS , -g [OZ; `aauepae!D aalseN �4unoo ewouoS -6002 `aauepieg aalseW `puelAjeW `Alunoo loglel :s94n(3 pun 'plaH 9:)WO /uO!4!sod 'pa5uolaq army nog( yolyM 04 uol4ezlud5l0 algp4lanyz) ao :)[Al::) Special Awards or Recognition Received: As a consultant in the SCMG program "Garden Sense" jointly received "notification in March of a first place award in the 'Community Service' category for its Garden Sense program which is focused on helping home owners address water use in the home landscape, an important factor in responding to California's current drought. The program was a candidate for a Search for Excellence (SFE) award which will be presented at the International Master Gardener Conference held in Council Bluffs, Iowa in September, 2015." Please state reasons why you want to become a member of this Board, Commission or Committee, including what specific objectives you would be working toward as a member of this advisory body: As a downtown resident of Petaluma, 1 am concerned for the welfare of the trees in my neighborhood. Some are water - guzzlers, some are poorly pruned and unhealthy, others suffer from "girdling" which strangles them. I would like to help educate the public on how to choose and maintain healthy trees which can, in turn, contribute to our health and to the beauty of our town. I think this skill is especially important at a time when our county is in such a terrible drought. Z l OZ ` L L aagopo pasjnaN 9 Loz `E aunt a#D4 ain}ou6l$ s,4uooilddy abed xoogaoej Allunwwoo snby Lfiuluado sly} 4nogp aoaq nod pjp mOH ON ® S3), lsaslaD }allluoa D gans 11 6ul +on woaJ ulplsgd 04 6ulplm aq nog( pinoM •4s9aa4ul 10 401guoa 1dl4u9+od a slsixa aa944 W94m sa9440w uo 940A o} 40u saagwaw Apoq A( OSjnpp 'paluloddo JID s4oaalp A:)ilod )Clio :4uawAoldw3 /uoljnziun6ap 10 aweu a4D4s asoald 'say( dl O N ® S9), Luoiljsod sjgl of pa.juloddp }j sagnp inoA 6upioped ul 4s9J94ul 10 4019u03 o pawaap aq ItAw 4o414u9wAoldw3 /uor4pzluo6ap Aun 441M pa4oloosso nod. aay 'OS WIL11 },uop I luoilaoljddn jnoA 6ulnnarnaa ul llouno:D All:) 944 o4 jnjasn aq pjnom laal nod. 4agj uolIpwaoIul a9g40 Aup aaaq} sl City ,of Petdumaj. California City:Board, Cammissiori and Com'mittea.Appf,catian Gity Gierk's office 485a 11 Eng,lish Street• f etaCuma., GA 94952.707.778:4.360• cityclerk @ci.p.6ta[um.a.c.a.us MAY .2 6 2015 Instructions: Use this form to apply to serve on any of the City of Petaluma, C a lifornia 's Boards, Commissions, or Committees. Please fill out the form completely. If a question does not apply, type or write N/A in the space provided. When completed, please forward to the City Clerk's Office City of Petaluma, 11 English Street, Petaluma, CA 94952. A11 applications are reviewed bythe City Council. if yv.0 have questions aboutthis.form, please c,ali the City Clerk's Office at 707.778.4360 or a -mail us at city clerk@ci.petaluma.ca.us. :Name: Matthew Cory Home Address; City, 'State.'khdZip Code: . Petaluma, CA 94952 j Phone: (If appointed, do.you wa.ntthfsnu-mberto be available to the pubiic?) YES . D.N.0 Do.you iiv.e within the Petaluma.City'.limits? © YES ❑ NO E -Mail; (if appointed, do you want this a- ddressto be available to the public ?) YES ❑ N'O lf-so; for flow long? Are you a registered• voter in. Petaluma? If so, for haw fang? Q YES ❑ NO 31/2 years 31/2 years m� E E ,U L UM `t3 a a� F- Oooe =886 I jolasunoo o©�32 (oosiouwj uas po Al!o) O Loa -sooa .taLjp-, jN dLu *eo jo spue!ad jegweVV paeoe :sa�O3 PUB plaH- a- oll101UOII!sod `panJas an9.4 nflA.saal:40 9ni13el3Ys9lpog lRjUGUJUJano g .!MlnaJd aapse-I MjoM `aoleutpa000 sl!ea.L eOlnaaS l -aapad sJeGAe& aolnaaS �Jed leuo!leN eeab uopeajoatl leuollaN GWO uaploE) WO4 p9al198 ' :JaAojdw3�UaseJ�l O N 83A O N 83A 1AIsnOlAoid sslpoq A:r3 4$plpoq Al! -3 aau o ao sly �o:6ul�eaw a pap.ua a nog( aneH Jaylo.JO sly. ol p.agdde Jo `pannainaa Ui lUb panaas no�C anUH 9e44!wwoo kos!npv jo!ues `serf 99141 WOO /GOSInpV ee.Jl swn!slad 14014m,osWisaaWwwo3 Jo `sUOlss!wwoO'sp4aog AIM .J�ll10 aBa jo sraa�t gg 9oalp, aq jsnw noA aa.4iwwo -q.A'rosjnpy, doruas aip UOo Gnaas.o, .:GJOJV Uo anaas o} 6uill!nn not GAu aoroyo Isill dndA ol.palulodda IOU �l :. :Isoiolul jo Faa�urwo3 Jo fuo>!sslwwo3 `pJaog mpow Civic or Charitable Organization to which you rave belonged, Position[Office Held, and Oates: San Francisco Conservation Corps Work Supervisor 1984- 2001 What Special Interests /Skills /Talents would you bring to this Board, Commission, or Committe.e2 �M40,99gr A, Awe Parks as a Trails Coordinator. I am very familiar with all aspectts of recreational Facilitation. and College, Professional, Vo.catlonal Schools Attended AMajor Subject; Dates, Degree /Date): ter Buddhist Studies 1985 -1989. UC SanFransico irrigation Systems Design 1988, -uoj!4nq!jluoo suinuaG *e ft� ew Lue 14p-ql I elwtu-nwwoo em pue Idnoj6 pooB Allew s aAuq 9M -enulluo.o of 9MIl pinom puL, 914!wwoC) kOSIAPV 99J_L GLII'uo Bunnies Alluelino lit ..:AP-Oq'AJOSjAPesl4jjo-joq - wow 13 st, . piumol 64!)IjoM- eq pinom no-A SOAIICb.fqo . jo uolssfwtuo3 Fpjuogsj4j 'jo jeqwowe ow000.q ol juem noA A4m''Sui9s99J.G1-P4s MOW PXeMV 001AIaS IUGWUIGAOID S91-elS Pei!un jew., AiueAk-L -. :PGAIG 00H UOI U600 -OH J6 SPJPAA..V JR1.0 ad 'is there any.other information that you.feel would .be useful to the. City Council in reviewing your application? I really enjoy being able to make a contribution to City of Petaluma. Are you associated with. any.Organization /Employmentthat might be deemed a conflict of interest.in. performing your.dutles iif appointed to this p.ositio n ❑ YES ED N 0 If.-yes;-please state name of Organization /Employment. City policy.dire'cts all appointed, advisory: body, members notto vote on matters.where. there. exists a-'potentiial conflict of interest. Wouid'-you b.e willing to�abstain.from voting if.such:a.co.nflict.arises? B YES ❑ NO Hdw diid -you hear.- about:this opening.? I received an email stating the my term is expiring. A.p plicant's Signature Date 15- levised Octoberll,2012 A 6u01 -Moy 1 0s Jl. �auir jq ad iir:aa o� patajsr5.aa p_noi(.aad. ON S3A �6uoj nnoy ao} `os.�fi s }!Luau. %4�� g unja ad.= ay }.:u y}�nn.an�� nod ofl; �° a3 :;.' (ZOlignd a.y . ON S3J�:=r: J. ,a11gn O a !j 1pna a O SSaJ O S) Ua7v1 G1.0�• O •' c�IUIOCidb �( .:'tl I.q 1. q F pp ul A p ) _l, W 3 ai l J _o ff a(gbppnp Jacj: o� ragwnw stye up n o�( op 'pa�u odelra !) .:aU' 'O :ap.oO.dtz ,pua:9 jb4s 'A4j:)'ssa.tpp.)f-at.uoH .� s111XC/' 7 Ci 7C/ ((D D i :auaaN � ` n-co-awn101ad•o @�lapAjlo to sn (aw -a lo 09Ek-gZZ -Z0L la a01dd0 sr)!ja13 Allo acll 1100 0 asoeld 'w,o4 sp� Inogo suoilsenb array not p ,punoo A�•a�ll Ag panalnal alo suolloollddo llb 7.906 b'3 'ownlolad 'laajjs Lp1bug I ('ownjolad jo O < ;AJID aol�p 3XG13 1140 014101 pJOAUOJ asoald 'palaldwoo uaLlM papnoid aoods ayl u1 YIN alpm jo adAt 'Xlddo lou seop uollsanb o I1 -Ajalaidwoo < H ! w.loj aq� Ino 1(11 asoald •saalllwwoD jo 'suolsslwwoo '3pjooEl 3,o!w0j1(o3 'awnlalad jO Allo a41 jo Auo uo 9/v@3 O.( A(ddo of wJol slpl aSn :suollon.rlsul O 3 sn pa auin�p ad !a��aaJ��( !a • 09��'8LL'LOL • ZS6 Z) lown.!a�ad... Q ��i� A16� uo! }a� jddd•aa41!wwo .pua:u.o!sslwuao0 'pir)o.g A41:). Board, Commission, or Committee, of Interest: Note: To serve on the Senior Advisory Committee, you must be at least 55 years of age. If not appointed to your first choice, are you willing to serve on other City Boards, Commissions, or Committees? If so which? Tree Advisory Committee Have you attended a meeting of this or other City bodies? Have you served on, interviewed, or applied for this or other City bodies previously? ❑ YES © NO ❑ YES NO Present Employer: Retired Job Title: Previous Governmental Bodies /Elective Offices you have served,' Position /Office Held and Dates: Fire Chief, West Jordan, Utah - mid to late 1970s. o5alloo Ieolugoal gein `A6anllejaW pue BulplaM `S`d :(04D(3/aOJ6ap 'salDo '.loa(gnS jo[DW) papu944y slooyoS IDUOI4D30A 'IDUOIssajO.id 'aBallo:) •(sgnags pue saaal umoa6aano Inogl!m) algessed s� jemapls Allo aqj eas o} a 11 pinom I 190}}lwUao:0.10 'uolsslWWO:) 'pJDOS sly{ 016uliq noA pinom s4UaIDJJSII!XS /sIs9194UI IDloadS 4DLIM :satDQ puD 'plaH a3l}}0/uol4isod 'paSuolaq anDy nog( yolynn 04 U0I4DZIUDBI algD4!JD4:) ao OlnlZ) C -Y\ 1 Special Awards or Recognition Received: Please. state -reasons why you want to: become a member of this,'Board; Commission or CommitteeJn616din14 whafi.sp:ec.ific objectives you would be working toward as a.member. of -this advisory body: TY s � M eJ- MAO z Loz ' l t lagopo pasl63M .944q. a�nqu6lS.:s,unOljticly . z6uivado -si4 4nogo- 100.4. noA..p p ^014::: ON SD), 'ISasjan j:?jjjuo.o.-a 406s.J160!ion u,oa� uin sqn o� 6uilji*- aq.iio : ,160M.. 1saaa }uj:o ;{allIuoo iplIua4od p sjsixa away- :aaa4nn saa,{}nw uo a9n.04 you saaquaa.ua- �(po.q �(ios�npn :'pa juo:dd a kip :4uawAoldcua. /uOIIDZIUDBIO.30 aLuDu 94n4s asaald `sa jj' ON SD,, 00141sod sILII o.j.paiwaddp: 11 sai4np•�rioX'5UiLuiop9d ul 4s9a94,uj Jo 4011JU00 p pawaap aq -4451W 4Dg4'4uawi(ojdw3 /u.014pzlUbBJo -Aup 441M pa4Aioossp noi( aay 600140ojj-ddp inoA-.Pq!naa.jjio.u3 an uio (uo aaOW. l a ( c n x l N O v v N-01 O .y N 0 s +r \ 0 M 10 �L .Q W N E L .0 7.. v N yam. 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',pddo jou saop ugb adWool s� p y gyj.lno p►j aspald •saa.11lu.rwoO.ro 'suolsslu.rwoJ 'sptaoR s,pturojjjD3 lowntq 'd, o'Xlt3'ayl jo Au'D uo anus of Aiddr) ol'ivao�'sty� asp :suorlarir {sul 3 < i.. �... • :'n:�a 10.0 09E1r'.BZZ 6.-.V, 'ZOL ZSbi' - puan�p�ad ::iaaals 1�:S11�U =''C:l:, y Ad i•f' , o - „' i uof}oai dd as ivacuo uo= uoisiltudto 0 14 .,.tf,,no e. on A' H • 1pr-Co p pe;. y Y McIrs 0 Advt u -.;rys 0�y-,U -Oth C o. "C'* ` "' " *:: - I "' " S 'So. omml.ssjoht Youth 'Commission Recreation, Music, and Parks Commission is w '6r.6 er •ave*, ou -y d-f6rjhli oth .H.q.V "Ci b. V Lisly y • ❑ Y ES NO YES ❑ NO S MOW.Y. American Red Cross Northern California Coastal Region -Regional Disaster Offic'er "`i6rve.d,�.P6 WbFp, b TIE�V, sit C) I �s .P Marin Disaster & Citizens Corps Council - member, 'Served July 2010 - June 2012 -ysllgqsa llounoo pue uoissiwwoo eqj sagljopd'agj pteWOJ'anoW dlay pue weal a ulor of pulua e yl!m-ui awoo i `siaq }o ao 'llounoo Allo agj Aci paysllgelso se uolssl :wwoo-agpoj sailtaoild juaaano ago `uolssluaua00 g hoh aye �o s�to_.a-luaaano eql 6ialzlubooai lrioyllM- .,,sant;oafgo oglocads• ACue ut• b pci lou op puia uolsin e Aluo poyglm ul autoo l •uoIssj.IbwoC) y ;noh M110 eqj of AjjOnwwoo .tno ul saejltd•os9yj'u9yj6u9jjs dlay of ssaubuillp Aw pue uojstn Aw 6upq o} juem I Itoddns i(}lunwwoo alglssaooe pue 'anljoa _4a 'Jua}slsuoo pua 's)laoNau laloos anlIlsod 'juawa6a6ua pue 4toddns Alluae; 6uoals;o jonpoid aqj se ssaoons aziu600ei AlaMpnjui am 1eyj os asay} lie 91lun o} sl aas i peexij olgauleIsns ayl ,slenpinlpul lo sdnoa6 lianas;o sa isep ayl ao 'eouewaojtad ollalyle laaa6 .to 'soluaapaoe 6uoi }s Aluo aI paingla4e sIuau.wanalyoe ao 's}uauagsildw000e 'ssaoons aas uo4o a/N ,glnoA ino aol Niomlou pallun pue 6uojjs a ajeajo of ewnleled ;o 40 aqI g11M NJOm 01 luem l •unnop >leaaq sjuawala 4toddns A.tunwwoo io 'laloos 'Alpe; ay} aay }la uegm ua.tpligo;o salllllgejeulnn ag1 of pasodxe uaaq pue uaas aneg l aaaaeo leuolssaloid Aw }nog6noiyl ,gInoA-ino;o ssaoons ayl .tol sluewele leol ;lio Ile aie laoddns A}lunwwoo pue ' laloos 'Allwel }eqj 97lu6oua t 1 -aouew.toped opepeoe y6ly ulaJuleW pua solJalLile looyos ul panlonul, aae py quepisaid sselo uewgsaa j se looyos g6ly 6upolue st sta}y6nep ino ;o auo allgm aaanseaal sselo joluas se epueaE) eseo je je9A joluas sly o}ul Wo6 sl uos inp 's811s slooyos atag} le salItnlpe aalnomino -eiWa ul panlonul aie pue Alleolwopeoe 6uoils lle ata Aagl •autnla }ad ul looyos 6ulpua4e lie are o4nn (0 L 'c! `90 ua.tp11 go aa.tgl aney I pue '•looyos aeallolN le aagoeaj juaiano e loj! n AN, _ r O 5 h q O't' a'ua::� ''s o :fip noM' o 'sari '�a a Ftu p M. n. p. abM 0 h � .� 1. .q. a 'r: r ?a d. u n uaiuc�;�•.'aa ow. sivauao•' •oo� �:s� o�a 'ui :tu'�o:-auoa'ar'• �o` uonn�no(.�� �'�:�swo oa�a oh sta ,. .�, .�•,. �f .P: 1 :�F. 3, �•:.R. .�.:..!•1�•'� . ,q:. ? :i•I. 7 ..�::�.. Cdr. quawabeueVI Aoua6aawg ul aouoltaox3 .toy, paemV puoutelQ - uolleloossy seolnuaS Aoua6jau 3 epopleo - :r` w .•1 . - 'a a.�a• ��uo •u6, e*% . d'• n Civic or. Charitable Organizatioh;tto which ...you have'beionged; Position %Office Held;'ciRd Dcitesr. Marin interagency Disaster Coalition - Chairperson, 2007 - 2011 Sonoma County Alliance Soccer Club - Board Member, September 2011 - March 2012 What: S `ecicti Irtteres #s /.Ski11s . flle.nts would. ou brin to this:Board ; Cotnr�ission, tot'Cornmitfee ?. - P /T y 9 , Have 20+ years experience -in government as a firefighter; emergency manager,. and US Coast Guard member. .1 have experience in organizational development, program design &. implementation, and .strong whtten•-and communications skills, l have strong experience in system design and identifying interdependencies for creating effectiveness and efficiencies, - - =Ca a �'e= �'Profe CR Oc IOR Sch, O s''Atferded'Nta or:Sub ct Dates�'De��r•e .Date g � ./ )'�, San Diego State University (Public Administration,-2000) Z L 0Z 'L I .tag0j00 pasJna� ;a 'o . :.a. a.. � p ' an 6 .b i uo •.ia:..: R I al!.s'gann ew nlelad 10 A110 ono q u. p.P � ON E] Slk J Basin. �r toa D. 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