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Instructions: Complete and sign this form and return it to Grand County Council Office, 125 E. Center St., Moab, UT 84532; fax: 435-259-2574; or firstname.lastname@example.org
(residency is required for all Boards; some District boards require residency within the District, which may not include Moab City limits; two years’ residency prior to assuming board membership is required for Planning Commission)
(applicable for Historical Preservation Commission and Housing Authority of Southeastern Utah)
I have read, and I certify, that all the information on this form is true and correct and I meet the requirements listed above. Furthermore, if appointed, I agree to faithfully attend the meetings and adhere to the State laws, County ordinances, and adopted Bylaws that govern the Board or Commission on which I am appointed to serve. Additionally, I have read the County’s Conflict of Interest Ordinance (No. 593, 2019) and do not have any inherent conflicts in serving on the Board or Commission to which I have applied. I agree to abide by this Ordinance.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
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