Application - Smith, Jim BMRC 2-14-08~t'~c s ~} P pu. c(~rZCo+J s~~r~c.~ES E ~ a r~op ~~ ~ ,~ rr~o~ Q,4-r~ «. r3 . v7
CITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION FORM
Please check (~) 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 ^ _ Tree Conservation Board
^ _ Cultural Arts and Recreation Advisory Committee ^ ~ Board ivlember Review Corrunittee
DATE: Z' 13. O $ APPLICANT'S NAME: eJ ~11a ~ 5 C, ~ M~ S to l TH
ADDRESS: ~ 3 OCEAN S t ~pE p R.
DAYTIME PHONE: Z~ b' S 6 4 0
EVENING PHONE: Sd q' I l ~ a
E-MAIL ADDRESS: J/µ ~ s'~cu/'eOpe , I9C~ FAX:
Zyb- 6750
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the boardJcommittee applying for.
14S TKO ON~tNE~- d~ MtVf.T~ th•E BVS-Nl~SSES ~a~. Oy~L`v~ ?wE+~Tf ~EL~M2S. 1 NAYS ~E~/Z.sONl1~t-t-`~
CON p-JG?ts0 !'(UNJO~I~s OfG PROFESS/oN~K- /NTt~~VtFWS I~ND EY~4LVdiTioNs FOB
Y,q/tto~S ~IoS~T[aNS~ !N ~4oot-rtvN, = bl~yE tGG-~v6p oN raN o~44L RAY-Ew
~ ~A~D f+o ~ o4nA to e.y ni ~- EYI4L V ~4 Tt ON S f OrC, 'lr'yl ({ JA ek S d N y l `t ~ SKc~i'~ e6F1
o f~ cE ~2E Sc'-~E uN t T
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.
Alit. A , ~r4n~~~- B~cN ctT[~~NS tNr~~St~ r~ SttirtnrG- nN e/~~
R-oAr~OS ~~ lENTITt.G~ TO t~y~ [dtuS~Ofsn.AZL~V /1~-A,~C~-SS' ~• ~~~
c Rev . a~c.~-cr c.~a t_ ~~/ c. c~aN , v/j- ~o GycA pure GoG4zta~/ c~ Ti~[i~
-~ S6~L°`N~ • /~`~~ /ri K C t NTG~iL1[6 E~ /4~1 ~~ '~o New R~luc~NrS
tNGw ~~ ~j4to2 /4ND yN8[~SGrD, wtZH /kY /JET~~L..~tfNp}Ztd/US
{f ~sErO d ~ SGT ~4-Nr! [4t Ei~t'T
Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
PLEASE NOTE: This application will expire two (2) years after date of submittal.