&1J4~ - City of Glendale

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CITY OF GLENDALE
PERSONAL AFFIDAViT IN SUPPORT OF APPLICATioN
PLEASE PRINT OR TYPE
DATE: July 9, 2009
FULL NAME MARDIROSSIAN
TIMMY
Last
First
Middle'
..Ii:Ai)
,~ (I'((;'
HOME '
RESIDENCE,~ ____________ ~~;~l~e~n=d=a=l=e~,~C=A~~~ _PHONE
Street City 7 StaielZip ------
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BUS~S7955 San Fernando Rd . Sun Valley
, Street City , StaldZip
BUSINESS
CA 91352 pHONE (8)8 252-1670
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" ,
' DESCRIPTION M 68 11 210 Brown Brown
Date of Birth Sex Hgt, Wgt, Hair Color Eye Color
DRIVER'S LICENSE NO.
List any and all.other names used for legal identification:
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SOCIAL SECURITY
./
Have you ~ been convicted of a felony and/o.r misdemeanor? If answer is "YES" list the dates, specify the
conviction, and identify the court and cas~ number.
NO
I HAVE READ AND UNDERSTAND THE PROVISIONS, RULES AND-REGULATIONS OF
THE CITY OF GLENDALE, CALIFORNIA AND THE MUNICIPAL CODE GOVERNING
THE TYPE OF LICENSE OR PE'RMI'r FOR WHICH I AM APEL YING, , ,
,
Organization: G&~ T-ransit Management, Inc.
K-182 (Rev_ 7/18/05)