Application- O'Bannon, Paula- CARAC, Parking- 6-28-16 d V23//q
• CITY OF ATLANTIC BEACH
BOARD/COMMITTEE MEMBER APPLICATION FORM
Please check(4) 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 Board Member Review Committee
* VI. Cultural Arts*and Recreation Advisory Committee ?c-vek i nc (' P u% \..,..24- P r,v t )AND
Sidew\k Co►vti�+ ee
DATE: 06/1s/26 ice APPLICANT'S NAME: -Rat-3A_ . ar._ o(ktrk0 t/ .._
ADDRESS: 3o`/ ( . 1 reet-
DAYTIME PHONE: 9 2 7/ — (J 1/170 EVENING PHONE: /l1A
,,,,./44;..p iN".
E-MAIL ADDRESS: 'pa LA6 . O bCtih0 —
Sr .
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
L. 6i/,1 i reli ree( CO1--7f 0r AVPkt. Atfr/ ( ;Sr/. .6644 1 "Al/hi-Ar-
3g = years G-`7)rzh/`� e /ntejTfr_a- scAooLs -7`41;M - ckolS' orea/r ,,
-lilt, area,. 7111,0cs / /It Ca ree r /Ave, S Pry/e;e efr `G2r/i '�c(llt�r/pri es
�I3€eit residpi.47v ' We., Aiwa 7.411 %A%ts Acs-dc , -L rAt_ hnta c._..
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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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l�/�, . ?(es e ry ct io �ie:t� I,-� coo vim. -(-o �0 r,hr t u�Y iD LO tom. •back.
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Si. (Loose& eit. i-,cGC�MISS i r QED
Please return completed form to
Donna L.Bartle, City Clerk, 800 Seminole Road,Atlantic Beach,FL 32233•
PLEASE NO the 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.
1
CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
''ease check (-1) the box beside each Board or Committee that you are applying to serve on. If you check more than
144.0e, 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
P sion Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: .-8/7- APPLICANT'S NAME: t (/� & , O1--/fC2/7
ADDRESS: 36..;-/ / S-fre;7
DAYTIME PHONE: 911 ,,q7/ D4/4/O EVENING PHONE: JD 5/ 2 7/ -d'/yO
E-MAIL ADDRESS: //y//SSO /SO'u_ FAX: NA
° nom
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committeea plying for.
L i t/4-S a� l r7`- sfe vA c .-- DexYa /Go, r- 3.. .Pa Ys,
/ 5AAr urs a exh1'G 15 `�C_o' -
Alt L l�iG tie U/�.Cl�i�,o� ��U a�Os
Ilir eretiCsc ���� ?a r 14 s O'er C.0' CA—s-_-7rt. _
W:e OCPA e� Y�c_0CA7L r..s , L •lilt C`- J
c4c Ls Vi-f:5-4),-,,--,x( /e4ceu -,' r /�
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.
L G/!-1-1 / /e-/-,..5-1..,. . /ii SPrv. d G• /`(�fe- liaav V4) Xe./.o
hr�� Z i`se4a../+/or-t- r vyr/' ? G7s- viz) o Gc ' CD/wh .
(41-t‘,e_ _7: T1 `S4.v 'A __
Se-We /i(:s '/ ,'_
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
,ASE 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.