Additional infomaition for 11-17-16 meeting CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(Ai)the box beside each Board or Committee that you are applying to serve on. If you check more than
one,please rank your interest in each board/committee by order of priority.
(A summary of each board/committee is available on page 2 of this form.)
Code Enforcement Board $ Community Development Board
Pension Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: I Z • APPLICANT'S NAME: (Li R. 43( 4'i ore
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ADDRESS: l t! L% i�!i�/1 AVe-nue---
DAYTIME PHONE: /D4'L • C2-4 EVENTISTU PHONE: To ei-.. 333. 7'
E-MAIL ADDRESS: (VVk t' , FAX: /O4"• 7/4 • e22--B.j
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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Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach,FL 32233
PLEASE NOTE: This application will expire two (2)years after date of submittal.
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CITY OF ATLANTIC BEACH
BOARD/ COMMITTEE MEMBER APPLICATION FORM
Please cheek(4)the box beside each Board or Committee that you are applying to serve on If you check more than
one,please rank your interest in each board/committee by order of priority.
(A summary of each board/committee is available on page 2 of this form.)
Code Enforcement Board Vj Community Development Board
_ Pension Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: \\- - \C) APPLICANT'S NAME: CA. a f(O, \L,,I
ADDRESS:
DAYTIME PHONE: C-2jC -��1�r EVENING PHONE: 01 k - \o
E-MAIL ADDRESS: Nri aOVEO,PM\5Q154-1.(Ta- FAX:
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.Bartle,City Clerk, 800 Seminole Road,Atlantic Beach,FL 32233
PLEASE NOTE: This application will expire two(2)years after date of submittal.
1
CITY OF ATLANTIC BEACH Received
BOARD / COMMITTEE MEMBER APPLICATION FORM
NOV 2 9 2012
Please check(4)the box beside each Board or Committee that you are applying to serve on. If you check more than
one,please rank your interest in each board /committee by order of priority.
(A summary of each board/committee is available on page 2 of this form.) Office of City Clerk
Code Enforcement Board Community Development Board
Pension Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: // —/ APPLICANT'S NAME: 1 4 t I {'t'1 t'I�
ADDRESS: i [ G -- -
1
DAYTIME PHONE: 21 i --fl i` J EVENING PI-TONE:
E-MAIL ADDRESS: t .-fie czr-41eiLe-J' FAX: . _._---
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
S-1-crrm G r c(f-
y
d GM\ e
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.
a a Ai& 'k—f-Af—Y--- Vk INNOR Let- tiAaks.
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road,Atlantic Beach, FL 32233
PLEASE NOTE: Members of the Code Enforcement Board, Community Development Board and Pension Board of
Trustees are required to file Statement of Financial Interest Forms. Also, information regarding"Conflict of interest"
is provided on page two of this application. This application will expire two (2) years after date of submittal.
CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check (V) the box beside each Board or Committee that you are applying to serve on. If you check more than
one,please rank your interest in each board/committee by order of priority.
(A summary of each board/committee is available on page 2 of this form.)
Code Enforcement Board ✓ Community Development Board
Pension Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: 2/5/2015 APPLICANT'S NAME: Steven Mandelbaum
ADDRESS: 906 Stocks St Atlantic Beach Florida 32233
DAYTIME PHONE: 301 602 7215 EVENING PHONE:
E-MAIL ADDRESS: steve.mandelbaum @gmail.com FAX:
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
While living in Maryland, I worked with the home owners association to establish community by-laws that protected and enhanced and
protected neighborhood and did not violate any existing city code. This expericne has given me greater insight into working
on a committee for the greater good of the neighborhood.
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.
I am currently a home owner in Atlantic Beach. I am interested in perserving the character and beauty of the city. This board
is an intergal part of acheiving that goal. Additionally, I am interested in serving the greater good of the city.
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
PLEASE NOTE: Members of the Code Enforcement Board, Community Development Board and Pension Board of
Trustees are required to file Statement of Financial Interest Forms. Also, information regarding"Conflict of Interest"
is provided on page two of this application. This application will expire two (2) years after date of submittal.
1
CITY OF ATLANTIC BEACH Receive/d0/05
BOARD/COMMITTEE MEMBER APPLICATION FORM
DEC 222014
Please check(4)the box beside each Board or Committee that you are applying to serve on If you check more than
one,please rank your interest in each board/committee by order of priority.
(A summary of each board/committee is available on page 2 of this form.) Office of City Clerk
Code Enforcement Board / Community Development Board
Pension Board of Trustees " Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: /g'ACC tit APPLICANT'S NAME: _J ud2 y /4D'e c r. I — 44 '7
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ADDRESS: 787 he,No 2cQ
DAYTIME PHONE:0)00 q53-T 6 7 77 EVENING PHONE: 5avnt
E-MAIL ADDRESS: i h t o4"am 6)y .koo , FAX
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Call
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.Bartle,City Clerk, 800 Seminole Road, Atlantic Beach,FL 32233
PLEASE NOTE: Members of the Code Enforcement Board, Community Development Board and Pension Board of
Trustees are required to file Statement of Financial Interest Forms. Also, information regarding"Conflict of Interest"
is provided on page two of this application. This application will expire two (2)years after date of submittal.
1
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