Application- Wood, Faye- CARAC- 1-22-16 CITY OF ATLANTIC BEACH
BOARD I COMMITTEE MEMBER APPLICATION FOIacFeived
Please check (V) the box beside each Board or Committee that you are applying to serve SAW y2n2 c> ', i 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 of City Clerk
Code Enforcement Board Community Development Board
Pension Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE : /.-- Z 2r .201(g APPLICANT' S NAME: Fail- pli ` wco j
ADDRESS : Rt JJTh Steel-- Af Jo itc eu. ( 1' - FL--
DAYTIME PHONE : CAN * 1.10 -S , � 9 72-) EVENING PHONE : 51Th'1- E,
E-MAIL ADDRESS : rthwb c4 Lj 6)(fe cintil, (uint._ FAX: A/ c, ii - ---
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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Received
JAN 222016
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
Office of City Clerk
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 .
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