Application-Trussell, Catherine TCA 7-8-10 714+1- q/ 0 ��.
CITY OF ATLANTIC BEACH 00
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check (Al) 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.)
Code Enforcement Board Community Development Board
Pension Board of Trustees •
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Cultural Arts and Recreation Advisory Committee ��''� h V hG. t
DATE: 7 - a -) o APPLICANT'S NAME: 64 ken . r °e C_- .
T us5tej
ADDRESS: 35 ' 4 ail C 3a.c,4 / ,3_ .2,33
DAYTIME PHONE: (240,- se I I NG PHONE: _
HONE: g�p� '7/3J
E -MAIL ADDRESS: Cr / j R ossglia Opt, FAX:
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Please explain any employment experience, board/committee experience, and /or community volunteer experience
relative to tie board/committee. applying for.
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Please provide a brief - xplanation of your interest or any special qual ' cations yo have in this field and ur reasons
for wishing to be appointed to this board /committee.
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/ Please return completed fo , to � � ' � Q . • ,� �i �► ' �`
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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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