Board Member Committee Application v CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FOF.EVENED
Please check (') beside each Board or Committee that you are applying to serve on: JAN 3 Il 2007
(A summary of each boardicommittee is available on page 2 of this form.)
OFFICE OF THE CITY CLERK
0 Code Enforcement Board D Community Development Board
0 Pension Board of Trustees 0 Tree Conservation Board
Cultural Arts and Recreation Advisory Committee 0 Board Member Review Committee
APPLICANT'S NAME: LelyADDRESS: '742- D A..h v)6t..L '" a{Cti
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DAYTIME PHONE: 9 C t.i f .94 q 5D if to EVENING PHONE: /D`t J • S 2)
E-MAIL ADDRESS: Lon 6-446 Q J I Sold-1 • FAX: ID II c)i • 5
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 ir.tcreA 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 �.�s
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach,FL 32233 --i-p L 1 . .
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RECEIVED
CITY OF ATLANTIC BEACH 3 . _w.
BOARD/COMMITTEE MEMBER APPLICATION F8KM
OFFICE OF In CITY CLE
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Please cheek 0)beside each Board or Committee that you are applying to serve on: RECEIVED
(A summary of each board/committee is available on page 2 of this form.)
Code Enforcement Board Community Development Boi V 0 3 711ffi
Pension Board of Trustees Tree Conservation Board
Cultural Arts and Recreation Advisory Committeet,/... OFFICE OF THE CITY CLERK
APPLICANT'S NAME: 7&V+1I Ar 4 Iv c r"rcrvr
ADDRESS: 9343 l r -;, w Lie rt/6; 4' -4A t t c (
DAYTIME PHONE: 600 304- — I o2 Db EVENING PHONE: 6-0 4} 2 fid- 24.9.2.
E-MAIL ADDRESS: e1 ♦ 1 ..10t4,04. A al... c PAX: 4/6/Ver-
Please explain any employment experience,board/committee experience,and/or community volunteer
experience relative to the board/co mittee applying for. J x'
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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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DCT-17-2006 11 : 36 A'1 FCCJ 9046462396 P, 02/02
Oct 1O 06 09: 15• Donne Bussey 904 247 5946 p. 1
CITY OF ATLANTIC BEACH }ge-r
BOARD I COMMITTEE MEMBER APPLICATION FORM
Please check(4)beside each Board or Committee that you are applying to serve on'
{A summary of each board/comminee is available on page 2 of this form.)
0 Code Enforcement Board L, Community Development Board
3 Pension Board of Trustees 0 Tree Conservation Board
"114, Cultural Arts and Recreation Advisory Committee 0 Board Member Review Committee
APPLICANT'S NAME: /4>f.' �' cc,.J a d2
ADDRESS: 117 C`j <(-1 4 1..f/i/e-"
DAYTIME PHONE: 40/4.--2 O j 2 EVENING PHONE: 07 y7- /9 7 d
E-MAIL ADDRESS: /WI 4,/*X0 eFCCT Ov FAX:
Please explain any employment experience,board/corrunittee experience,and/or community volunteer experience
relative to the board/committee applying for. ,,
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Please provide a btiafexplanatioa c{ b3i your interest or any special qualifications you have in this fie d and your reasort
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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