Application- Trussell, Catherine TCA- Withdrew 9-4-10 W eal /4'/io
CITY OF ATLANTIC BEACH 0(15
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check (ii) the box beside each Board or Committee that you are applying to serve on. If ou check mor
one, please rank your interest in each board / committee by order of priority. y more than
(A summary of each board /committee is available on page 2 of this form.)
Code Enforcement Board Community Development Board
Pension Board of Trustees
Cultural Arts and Recreation Advisory Committee Tee V ��' I 1
DATE: 7 - 8 J O APPLIC'ANT'S NAME: 6f4er ne, • 1 12, V55e1 i
ADDRESS: 3'5'-/ // LZ/t e
DAYTIME PHONE: 4�' - „SQ�' E �1/
a�
E Ne PHONE: 9602- 2 /3 /7
E -MAIL ADDRESS: 6- % j R t.45 - 5 . . 4a., FAX:
—
COQ
Please explain any employment experience, board /committee experience, and /or community volunteer experience
relative to toe board/committee. a for.
0 iie„, , ge. 1.. 41 - ,I. 0 -4 we t ....e .1.,,,, "T5_11
g mei____
1 P.- .elc &?scaQ
V _ 13.4.6-est..- -....10 , P • AP -
/ ! / '4 , / •;fi r '1 / -
1
I1 • A .. /tom i... U... .Aa!_. './ C7,114Y1'/ 1_4,', _ `
T_P c-) a 8 i 1
• 4 II AIL: AL...A: -. _. . Pt-1-5" )
P a/A- , / il, ' • • — L /PlaAff--WhAaA^.aA-e--txeAA-V Re,,a_ fee
Please provide a brief - xplanation of your interest or any special quartfications yo have in this field and totir reasons
for wishing to be appointed to this board /committee.
3 viAk k0.- / i /I „. AIL / / 46.646.- *
tt - 1 ali if _/e ' •
i-e P '
Jai .i.i !/./ i A • lit :, // ' . �' , '_e___!•.. ... - ....//: /, ,1 4t ,.... .4.#
,,, ,i."..2 - ,./.•
7 • ,
a/ea:6 -,-., . ed"-,64... ...a 4...! . • ' ' . .. /AL .44: ..” ' Fir -
eA•i. ellitA___6
. • _do" .1 ..4.1 2 2s; 'AK / ' / /AL ,... 1 • AO -di: A ___,W2,41-seie.60?
. . A... AZ .. � . , ,..r / • • ,, , I
Please return completed fo to �''' Q ��i i ► j
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233 I
PLEASE NOTE: This application will expire two (2) years after date of submittal.
1