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Board and Commission Application Form

  1. Personal Information
  2. Residency Information
  3. Are you a registered voter
  4. Are you currently serving on other City Boards, Commissions, or Committees?
  5. Conflicts of Interest
    Per RSA 673:7 and Chapter 5, Section 5-20 of the City Ordinances, a potential conflict of interest may exist if serving on more than one Board or Commission, as follows: Only one Planning Board member may be a member of the Zoning Board of Adjustment; either one appointed member or one ex-officio member of the Planning Board may be a member of the Conservation Commission; either one appointed member or one ex officio member may be a member of the Heritage Commission; a member of the Putnam Fund may not serve on the Trustee of the Trust Funds, and a member of the Trustee of the Trust Funds may not serve as a member of the Putnam Fund. For questions regarding conflicts of interest please contact the City Manager's Office at 527-1270, or email to NBrown@laconianh.gov
  6. Which of the following criteria makes you eligible to be a TIF Advisory Board member: (Please see TIF District map)*
  7. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  8. Oath of Office

    Please note that upon being appointed to any Board or Commission, applicants are required to be sworn in at the City Clerk's Office and sign an oath.

  9. Questions?
    For general questions regarding this form please contact Nancy Brown in the City Manager's Office, 527-1270, or email NBrown@laconianh.gov
  10. Leave This Blank:

  11. This field is not part of the form submission.