Application- Stinson, John M. CEB & BMRC 2-3-12 CITY OF ATLANTIC BEACH Received
BOARD / COMMITTEE MEMBER APPLICATION FORM
FEB - 3 2012
Please check (I) 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.) Office or City Clerk
Code Enforcement Board Community Development Board
Pension Board of Trustees )( Board Member Review Committe
Cultural Arts and Recreation Advisory Committee
DATE: 3 Fth ZIZ APPLICANT'S NAME: JOhn YYi S4ir tit
ADDRESS: 15 1 L +k fie-+ )14-lowvitc F3taa. Ft 32233
DAYTIME PHONE: G I °I( Orr Sab EVENING PHONE: y g53 421 6-
E -MAIL ADDRESS: Jbj 11.5 e4VJ / 44. k FAX: 83 2 55 3 2S1)9
Please explain any employment experience, board /committee experience, and /or community volunteer experience
relative to the board /committee applying for.
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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.
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Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
PLEASE NOTE: This application will expire two (2) years after date of submittal.
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