Amended Application- Lada, Jennifer PBOT & BMRC 2-19-16 Lit I Vi' A I LAIN 111. ISLALri
solielt
i 1 I BOARD 1 COMMITTEE MEMBER APPLICATION FORMceived
Please check ( J) the box beside each Board or Committee that you are applying to serve ons `IP you ch2 J 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
t/ Pension Board of Trustees X IVA Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE : ? t St l vs APPLICANT' S NAME : (if- X k Lfolaa,
ADDRESS : \ rar■°\ 2 B. I vd) Pautifc h aci l a a 33
DAYTIME PHONE : CDLJ La ' l0 J 4 I EVENING PHONE : ca. ale---
E-MAIL ADDRESS : Lt,—P- 4 ll 9/At1W \- Z : n pc
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
�1 ek at, 4 _>'ii.1r. • k IS '
Sig . .
-W tI A I . & A%AJS . •11 ' r 4 Ure, • ) . Si
tea' at Wbrebn t k My i th 011
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.
1I . . AO1 ' ♦. /LSD lin 114,.. •. ( 1a.A .S Alt . 114, is f1 A &#A .AA
I
�n��rllll�/..�.�i/, . . /'I . /. r ir!iithe A i
.ul(!t� i � / � . TV . � , lr l /iii i
`
We _inns a_ysig A d 04 „ . _a/ _ g }Irani 44 -riat..!
,I [ !J �� •� _ � � . I .v_ • � i. _ aci ii, M'u a A' • a e •
. .uR. 1 . . A L. . ' - JLLa •.' .1 ! (D! ' Lk1 . So
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