Application - Harvey, Susan ESC 12-12-22 - Withdrew on 11-13-23 CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(J)the box beside each Board or Committee for which you are applying.
❑ Board Member Review Committee(BMRC) 0 Community Development Board(CDB)
❑ Cultural Arts&Recreation Advisory Committee (CARAC) Environmental Stewardship Committee (ESC)
O Pension Board of Trustees(PBOT)—Police 0 Pension Board of Trustees (PBOT) -General
DATE: V/1'2/2�
APPLICANT'S INFORMATION:
FIRST NAME: Sus a, LAST NAME: 1A--6t.r v.Q
ADDRESS: - qm- SAY
CELL PHONE: ,?0(47 • 3a- HOME PHONE:
PRECINCT/DISTRICT: E-MAIL ADDRESS: S&.S&v to hOY @ ccwlc' 4.
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Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
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Please provide a brief explanation of your interest and your reasons for wishing to be appointed to this
board/committee.
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NOTE: This application will expire two (2) years after date of submittal.
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
Rev. 2-13-20 Page 1 of 2