Daugherty, Jonathan CEB &CDB 3-19-09
CITY OF ATLANTIC BEACH BOARD COMMITTEE MEMBER APPLICATION FORM Please checklthe box beside each Board or Committee that you are applying to serve on Ifyou check more than one please
rank your interest in each board committee by order ofpriority Asummary ofeach cboommaitrtede is available on page 2 ofthis form Code Enforcement Board Community Development Board Pension
Board ofTrustees Tree Conservation Board Cultural Arts and Recreation Advisory Committee Board Member Review Committee DATE I 1 O ASPPLICANT NAME J d f 11e ADDRESS V v T SClJS Sr l i
rc G DAYTIME PHONE l06 D b EVENING PHONE Ste EMAIL ADDRESS Iam Qhi1Gt CdN FAQ Please provide abrief explanation ofyour interest or any special qualifications you have in this field and
your reasons for wishing to be app ted to this cboomamritdte PLEASE NOTE This application will expire two2years after date ofsubmittal 1 Please explain any employment experience cboommaitrtede
experience aonrdcommunity volunteer experience relative to the cboommaitrtedeapplying for Please return completed form to Donna L Bartle City Clerk 800 Seminole Road Atlantic Beach FL
32233