Michael Douglas, Jr. RECEI t_
CITY OF RC %MEAD
[EC _ '11998
CITY OF ROSEMEAD CITY CLERK'S OFFICE
APPLICATION FOR TRAFFIC )l PLANNING COMMISSIONER
Please print/� or type:
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NAME: I I I°VIAW tL • vel-Asir
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ADDRESS: �� 3� uL aNNET Ave- VosEenDao
RESIDENCE TELEPH/ONE:2 2 I104 BUSINESS TELEPHONESb2 �c3 ,r1I
DATE OF BIRTH: b - MALE: FEMALE:
ARE YOU A REGISTERED VOTER IN THE CITY ��O77F ROSEMEAD? )C s
HOW LONG HAVE YOU LIVED IN CALIFORNIA? 1r1 ROSEMEAD? 22yes'
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EMPLOYER'S NAME: V2-1260t i12-0C-45-7
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BUSINESS ADDRESS: le? 10-Z 190 t ntrq �151V.2 c1 c T L 14 S0673
TYPE OF BUSINESS: YhF6- A 'Rr- wn-- Oc 3UE -Y E"tc Cxz. gtr
OUTSIDE BUSINESS INTERESTS: `ty f C,A- ncc n c t2-t
EDUCATION NAME & ADDRESS OF SCHOOL NO. YRS YEAR
ATTENDED GRADUATED
ceit L.1 S Jnodr
Grammar School '( ca- '^'-R^-%
Saa roam gl Fi, s tivl
High School �'-`� T' G�r''t°( "1 r1
yr 16:
(r.A.
-Thact Tisch ryNo
College or Univ. La; romacksJ
Night School or $-
Corres. School
PROFESSIONAL AND BUSINESS ASSOCIATIONS: CA`- OSc}nt?
CnNrrczeLLP N L1CC..3.;e
ARE YOU DISQUALIFIED TO VOTE IN THE STATE OF CALIFORNIA, COUNTY OF LOS
ANGELES, DUE TO A FELONY CONVICTION? 1‘ 0
I AM PRIMARILY INTERESTED IN SERVING ON THE PLANNING COMMISSION
(Meets the first and third Monday at 7: 00 p.m. )
I AM PRIMARILY INTERESTED IN SERVING ON THE TRAFFIC COMMISSION X
(Meets the first Thursday at 7 :00 p.m. )
PERSONAL OR BUSINESS ACTIVITIES THAT WOULD BE N CONFLICT WITH YOUR
SERVING AS A COMMISSIONER:04G4P p.1W = c o1.7. /O'\tom es- CD`^^�•�y N'tv}
ADDITIONAL INFORMATION YOU FEELJ. � �WyO�ULD BE HE FUL TO THE COUNCIL IN
MAKING ITS DECISION: T PacmI , Y<Ke*fl� 0 72- v:" y }'" cp'-444
1r Q, nC trIratiS 1 42 T`+�. c.A5 i'- VAn 1 "Cu'CJt== \l{/20
Voir
.
DATED: II-3- of . �l Au-
Applicant Sik at re\
Note: This questionnaire will be kept on file for consideration by
the Council in future Commission appointments.
E.41: 12