Mears, Barbara CDB, CEB & TCB 11-04-05 v CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check('1)beside each Board or Committee that you are applying to serve on:
(A summary of each board/committee is available on page 2 of this form.)
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-2/". Code Enforcement Board Community Development Board
Pension Board of Trustees Tree Conservation Board 31"'
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: .13/4 12_40A QA MEA/ZS
ADDRESS: I 66 4- C'oQh i iJ o4 FL - ATLp Ayr 7 G A
DAYTIME PHONE: 6 04 o7-2$14- EVENING PHONE: O4) -'ID'
E-MAIL ADDRESS: q freil;bit bS Q ycttao .CDM FAX: C ,4)
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 qualifications 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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