Smith, Jim CDB 11-13-07 CITY OF ATLANTIC BEACH
BOARD/ COMMITTEE MEMBER APPLICATION FORMEECEIVED
Please check (�) beside each Board or Committee that you are applying to serve on: NOV 1 3 2007
(A summary of each board /committee is available on page 2 of this form.)
OFFICE OF THE CITY CLERK
❑ Code Enforcement Board (/ Community Development Board
❑ Pension Board of Trustees ❑ Tree Conservation Board
❑ Cultural Arts and Recreation Advisory Committee ❑ Board Member Review Committee
APPLICANT'S NAME: 1A SM ( T N
ADDRESS: — 7 cl�
DAYTIME PHONE: SC O y EVENING PHONE: 56 1 - ( y
E -MAIL ADDRESS: J I Pn cW e ..-n 2 - p FAX: Z '4 G
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 or any special qualificationc. you have in this field and your reasons
for wishing to be appointed to this board/committee.
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Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
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