Application- Coleman, Ray CDB 10/22/07V:y 7 Lu~~ ~i ~(A~~V~ ~Zi;Ui?Vlle f~r;U*?.ll i~ I~;l jF~y F' h
al Y x u-r x,. LANTIC BEAC~I `
BOARD I C4MMrT'TEE MEMBER APPLxCATION JFC)~I
1007
l'lcase cheek (~) beside each $oard or Committee that you are applying to serve nip;
{A summary ofeach board/cammittee is available on pate ~ of this for/m.)'
~ Code Enforcement $oard C+~1" Cam~snunity TJeveXopment Board
Pension Board of Trustees ~~ Tree Conservation Board
C Cultural Arts and Recreation Advisory Committee l~ Soard Member Review Cnrnznittee
~~ ((~~ r -1
APPLICANT'S NAME: ~aC,JIC Gt.~(,~,___ ~_~_~
ADDRESS: ~- `~_____L/1. I C•t~ ~ ?,.~~ G ,L~~X~=_
DAYTIME PHONE: ~,~~~~~ EVENING PHONE: ~~Z~~f /.~~C~
E-MA1L ADDRESS: i~a~{.I~~JN~~Bcc~~_ FA.~{: ~~ '_ ~ [~
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Please explain any employment experience, board/eomrnittee experience, andlor cornmututy volunteer experience
relative to tbcboard~ommittee apt~yisaft for. _. a ..
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Please return completed form to
Donzra L. Busszy, City Clerk, 80a Seminnie Road, Atlantic BeacYr, FL 32233
Please provide a brief explanation of yaui interest or any special qualifications you. ha re in this field a,nd your reasons
for wishing to be appointed to this boardJcammittee.