2021-12-07 P & Z Packet - Laserfiche WebLink

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CITY OF CENTERVILLEREQUEST FOR ACTION Agenda Item # Department: RequestedMeetingDate: December , 2021 ation VI. TITLE OF ISSUE: Annual Re-Appointment, Disclosure of Financial Interests & Payroll Documents BACKGROUND AND SUPPLEMENTAL INFORMATION: Included in your packet, you will find a packet that Staff requests you complete for re-appointment to the Committee along with Disclosure of Financial Interests, Payroll Direct Payment Authorization, 2022 W-4MN, Minnesota WithholdingAllowance/Exemption Certificate and Form I-9. We understand that not every form can be completed this evening, but we would request that the Letter of Re-Appointment and Disclosure of Financial Interests be completed and turned in to City Administrator Statz prior to leaving. The payroll documentation should be completed A packet will be placed before you at the dais so there is not need to complete and print on your own unless you desire to. COST AND SOURCE(S) OF FUNDING: N/A REQUESTED ACTION: Complete items as instructed. For ClerkÓs Use: SUPPORTED DOCUMENTS ATTACHED Motion By: ____________________________________ Resolution Ordinance Contract Minutes Plan Map Second By: ____________________________________ Aye Vote Record: Nay __________ Packet on Dais. Other (specify) ____________ __________ __________ _______________________________________________________________ _________ _______________________________________________________________ __________ _____ _____ _____ _____ Refer to: _________________________________ Tabled Until: ______________________________ Consent Other: ___________________________________ Regular