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COLUSA COUNTY BOARD OF SUPERVISORS APPLICATION TO FILL A VACANCY UPON COMPLETION RETURN TO: Clerk to the Board of Supervisors 546 Jay Street Colusa, CA 95932 (530) 458-0508 [EMAIL REDACTED] Office Use Only Date Stamp APPLICANT INFORMATION NAME OF COMMITTEE/COMMISSION/DISTRICT/OTHER: NAME OF APPLICANT: ADDRESS: CITY: PHONE: E-MAIL: SUPERVISORIAL DISTRICT: (Circle One. If you do not know your Supervisorial District please note, or list your County Supervisor’s name.) 1 2 3 4 5 LIST ANY QUALIFICATIONS AND/OR REASONS YOU WISH TO SERVE ON THIS COMMITTEE: Office Use Only: APPOINTED TERM NOT APPOINTED