Application- Brotman, Solomon CEB, CDB BMRC 2-1-13 CITY OF ATLANTIC BEACH
BOARD I 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 3 Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE : ,Z h � 1 -6 APPLICANT' S NAME : So L O m o .N., ( So L ) G • ' i ` oTh'n A `J
ADDRESS : Zoo t (-AviiN3 ' ) `L. 32233
DAYTIME PHONE: 3 `t O `� t EVENING PHONE : 2 ' `I 2O 4
E-MAIL ADDRESS : SC Bi2o74 rn 6), PItoD16 %r . 1\af FAX: 39 0q I
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
5 rn L. L Bus t x ,55 wag. 2. S ‘1 (-: IA 12S
coRMCR- CoQ_ Po : A t- C0.0 aNVoLV ) -1) OLotsoWN rgAL.TImo . t R ` b t— LbPenCi•i 7uE Ig8OC
as CNCAP- IL0P. C9IA le42J 14 ( h. +75 Ow JAY (3Nc. J4 JEwisu rRAroiLt
c'
corninuN 11`1 CARytC“ JActatNvus LnCpcLS £.. GLOB Mgtrp. t/ UEML TLt Corn ^, DAP-D
p . SI C 1im1Ca: y , LctisplP Acksor,vILLki C ftD NI CorNPlc`t . r E
o i , JACtsoNaVILL `t
' t ( NT_S Com cv% Sloca Copp ° 14 (nit £ 42J
ratIA) 0::
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.
2o ' Gra2_ !Rts It f pc qi L. r N1 vC `8 PCla
CNcIRE,b Cr onet ti T£ 4 TI-OLYT 4 c3/44 ,APTEts (1,oP J n.>i 1< ,“ k; \IRA' S Okbtr.rnruc S _
Ce>rN. `, uITAt- To Y- LOQll7 1 De: -Pr OC I, � L. u f� EGA 't271 � G VioL. n 'r\ rJ S or CLOrLiDJ
vTQ T`-li ,< 4 ILorck -o Ft ifxbrn „& \ S rfL ,n i\v a Coal
C. WAtl2 `c.3) k A J LID ICAr4. D kw Lib QtbL 0C tCS () Nib R • PTE2 (it
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