Application- Johnson, Jerry L. BMRC 2-6-2008CITY OF nTL~~iTIC BEACH
BO.-~R~ / CO1~il~lITTEE NIEl~1BF~Z APPLICATION FOR1'~1
Please checl: (~) beside each Board or Committee that you are applying to serve on:
(A summary of each boardicommittee is available on page 2 of this form.) '1=~.~ ~ ~ ~~~~
t:f~t~E `~t~ttt`~ [~ITv CLERK
^ Code Enforcement Board ^ Cor~~i~mty Development Board
^ Pension Board of Trustees ^ Tree Conservation Board
^ Cultural Arts and Recreation Advisory Committee Q' Board Member Review Committee
~ > .~
APPLICANT'S NAME: ~.)P, C' f'~,1 ,~C _ . ~ )~g
ADDRESS: ~~~3 ~~ ~~- i~~G~w, ~~~n, ~~~~~ ~ r`~w~~~ i~ ~~~~,1,
DAYTIME PHONE: ~fD~~ a~~ /~~~ EVENING PHONE:
,~. /~,./I S~~t-I~ r~~
E-MAIL ADDRESS: J r~S J C's'y f s~ FAX:
Please explain any employment experience, board/committee experience, and/or community volunteer experience
re tive to the board/committee applying for. r' r
S~~t L~i ~L' Rd ~Nc, C~r-~ ~~Ax~~, n-~r ~1 C~A~A ~ WI ~ ~~-~~Arv ~ t C-~ e ~ ~? S
Please provide a brief explanation of your interest or my 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
i~t SSe ivy , ~ ~~ ~ ~ ~~ i ~ F 1,~ r~ . c ~ r} -~ i /~ ~ ~ ~ 2~ti, ,4-~ , o~ ~„ w1~ ~n ~~ .~ ~