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Application to Serve on Buchanan County Board

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Name*
Address1
Address2
City
State
Zip
Cell Phone*
Work Phone
Email*
Business Name*
Occupation*
Business Address
City
State
Zip Code
Which board would you like to serve on*
History of other board service*
Explain briefly why you are seeking this position and identify any qualifications and your interests regarding service on this board*
Do you or any related family member have any financial interest, directly or indirectly, in any contract or subcontract with Buchanan County*
Do you or does any related family member(s) have any other interest which micht conflict or be perceived to conflict with your duty of loyalty to the interests of Buchanan County? If so, identify the interest and the relationship*
Are your Buchanan County taxes paid in full to date*
1. YES
2. NO
Are you related to any of the Buchanan County Commissioners*
1. YES
2. NO
If YES; how are you related