Boni, Rita CEB 1-21-09
Received CITY OF ATLANTIC BEACH JAN 2 1 Z9OQ BQARD ICITUTNEIElI MEMBER APPLICATION FORM oenor cKy tcc Please check the box beside e ch Board or Committee that you are applying to serve
on Ifyou check more than orie please rank your interest inehboard committee by order ofpriority Asummary ofeachicbtootmearemdis available on page 2 ofthis form Code Enforcement Board
Community Development Board Pension Board ofTrustees Cultural tAs aitdRAedcvreisaotioryn iCttoemet Tree Conservation Board Board bomber Review Committee r DATE I Zj5 flU ASPPLICANT NAME
1f i1 r ADDRESS 1ytS G 2 GC1 3cc33 3 1 DAYTIiVYE PPIONE l EVENING PHONE O Y rlf f EMAIL ADDRESSiLcanl1 Ni FAxqo i I Please provide abrief explanation ofyour interest or any special qualifications
you have in this field and your reasons for wishing to be appointed to this cboommaitrtede Yw2 Please return completed form to DonnaL Bartle City Clerk 844 Seminole Road Atlantic Beach
FL 32233 PLEASE NOTE This application will expire two2years after date ofsubmittal Pleaseaeixmpany employment experience cboommaitrtede experience aonrd community volunteer experience
relative to the cboommaizttede applying for