Putterman, Joshua CEB & PBOT & CDB 1-25-2005 v CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check tv) 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.)
V Code Enforcement Board /Community Development Board
✓ Pension Board of Trustees Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: f oSiluc. I . ;,i4ere'kn
ADDRESS. a04-4- 5Crntn>L el
DAYTIME PHONE: c7b4-191-463't EVENING PHONE: qu,i- Z-
E-MAIL ADDRESS: 014c ptAf4 r @ aFAX:
Please explain any employment experience, board/committee experience, and/or community volunteer
experience relative to 11e 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 reasonslfor wishing to be appointed to this board/committee.1 L t,) + nV •
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Please return completed form to
Donna L. Bussey,City Clerk. 800 Seminole Road. Atlantic Beach_ FL 32233