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Please return the completed form to: Mayor@northamptonma.gov or
David J. Narkewicz, Mayor
210 Main Street, Northampton, MA 01060
This information is optional and will be used for diversity purposes only. Complete it only if you wish to do so.
Please indicate the boards and committees you have an interest serving on.
The filing of this form does not guarantee my appointment. An application is kept on file for two (2) years; after that I must
file a new application. Being appointed to a committee, board, or commission means that I am considered a Municipal
Employee under MGL Chapter 268A and thereby subject to Conflict of Interest Law MGL Chapter 268A, Financial
Disclosure Law MGL Chapter 268B, as well as Open Meeting Law MGL Chapter 39: Section 23B. I understand that I will
take the conflict of interest test after being appointed and that I also must be sworn in by the City Clerk. I will contact
the appointing authority with any questions about my service.
Important: Once this form is submitted it becomes a public
document, if there is information you do not want open to the public please do not include it on this form.
This field is not part of the form submission.
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