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<br />, ,O~-21;~3 08:33AM <br /> <br />FROM [GOV4IjOR'S OFFICE <br /> <br />P002 <br /> <br /> <br />TO 986644 7 4 <br /> <br />. <br />STATE OF COLORADO <br />APPLICATION FOR BOARDS AND COMMISSIONS <br />OFFICE OF THE GOVERNOR <br /> <br />FOR OFFICE USE; ONLY <br /> <br />Please attach a current resume <br /> <br />BAS <br /> <br />BC 1 <br /> <br />BC2 <br />BCB <br /> <br />OOGtd or CO""""13310n for ........j(l~ you ~,~ illPPlying: <br />Arkansas River Compact Administration <br /> <br />YOUH NAMI:; 1l.8St.f=lrSI. MldOlel <br />Lil~, Daries C. "Chuck" <br />tlomo__ <br /> <br />Water Conservation Board <br /> <br />5.S. . <br /> <br />Your Occupalion <br />Director <br />Pm88"t elf1)lO~ <br />Colorado <br /> <br />Coun,y <br /> <br />CoogrEPSStornI! Set'l;\le O'SI. Mouse 0'$1. <br />019lnC( <br /> <br />City <br /> <br />SHue Zio Coos <br /> <br />Dale 01 Bitt" <br /> <br />RsglSterea votet YeS Or No <br />Panv Allili3tlon Oem. Rep. <br />C~ One <br />8u:un8ss Pnono No. <br /> <br />GaMe, <br />.. F <br /> <br />Race: (elrel, one) A1r;C4n American Asian <br />Un 1115D8nl(; NatlYe America Caucasian <br />ReSIdence Ptlone No. <br /> <br />(3031866-3441 <br />~~ Addrna <br />1313 Sherman St. <br /> <br /> <br />p.r. <br /> <br />807.01 <br /> <br />LEVEL <br /> <br />EDUCATION AND GENERAL UALIFICATIONS: <br /> <br />LOCATION <br /> <br />High School <br />College <br /> <br />Ttaae/8ualnesslCorreapon<Jet\Ce <br /> <br />Memberships in <br />Organizations <br />and Offices Held <br /> <br />(Indicate If Past or Present) <br /> <br />Volunteer Activities <br /> <br />(Indicate If Past or Present) <br /> <br />Special Skills and Qualifications <br /> <br />(Including disability status, <br />if desired) <br /> <br />NAME OF SCHOOL <br /> <br />No. Yeats 01<:1 You <br />AllenCleCl GrsCluate? <br /> <br />Malor Course\s) <br />01 Study <br /> <br /> <br />/.,}, <br /> <br /> <br />tS &QL. (; , <br />~..J /?I~ <br /> <br />/, <br /> <br />5" <br /> <br />-!JJi.,. J2>-.r,' C<- '-'- <br />, <br /> <br />e~ C~-'- <br /> <br />L/~ '(!rJ.f. P <br /> <br />""-/06/:;' <br /> <br />Required by law to serve as Colorado representative. <br /> <br />Arkansas River Compact Art. VIII, C. <br />37-69-101 <br /> <br />C.R.S. Section <br /> <br />NAME <br /> <br />REFERENCES (list three pers~ns. not related to you. whom you have known for at least one year.) <br /> <br />ADDRESS <br /> <br />PHONE NO, <br /> <br />I certify that the facts contained in lhis applicalion are true and correct to the best of my knowled9~. I authorize investigation at all <br />statements contained herein a~dthe references listed above 10 give you any and aU in/ormation concerning rnyaualilications and anyperti. <br />nent if'lformarion they may have. personal or otherwise and release all P3rc;es from all liability tor any damages lhat may reSl.l1l from fUrnlsn. <br />jng the sarna to you. <br />Is there anything in your backgrounCl wf1ich might be a potenlial embarrassment 10 the Governor or yOu if il were to become public? <br />yes [@ II yes. 'lIease explain on separale sneer 01 paper <br />I undOf'St';"M that lhe Colorado Public Records Law rn;:t requira ttlat certain lnlorm '011 contacnod on this <br />appfleatJon be accessible to tho (;Isneral public. l3 I wh 11 sped~ mad~ nlid nlial by 5taltJle. <br /> <br /> <br />SIGNATURE ~ '-J <br /> <br />ReruRN COMPLEreO FORM TO: <br /> <br />1(QI"(lln R~k414 <br />OlroClor <br />BOQras CIne Comml6sions <br /> <br />Offico 01 The Governor <br />136 ~tate CapitOl eUllQlng <br />...-- -. ....-.-.-..- ..".."., <br /> <br /> <br /> <br />nAn: <br />