Johnson, Jerry BMRC Resubmitted 4-9-10 r 2 W,o
CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
RIVED
Please check {1) beside each Board or Committee that you are applying to serve on: ""(A summary of each board/committee is available on page 2 of this form.) B
t;tti0 T .CITY CLERK
Li Code Enforcement Board ❑ Cori .nity Development Board
❑ Pension Board of Trustees ❑ Tree Conservation Board
❑ Cultural Arts and Recreation Advisory Committee f( Board Member Review Committee
APPLICANT'S NAME: N.)t c�'� ,L vl vi S Q
ADDRESS: �►
AS1 ta•
DAYTIME PHONE: 9b pR'f 9 /G EVENING PHONE:
Vie''
E-MAIL ADDRESS:-.. 1r45) 0 cry 1(,sy @ FAX:
y
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
re Rd i N U Bo~A i A. c,-S- 1v1bf ( Lt+vcy O F cicei2c
S t J I or o C- i q 1 v t e 1 C.A ) PerL pc ,4/15 C i A.
S M , r r1 e,'a P / (a_90s4ft--hv i 10 10 16 imr:144 k e S'
I/0).v C elsec_u1' elR_, 7 Aga P&A ec scc ,c .
kik A09e. / LS .'q,e 1e'2 ceR v r ce, eon. .. C'�, m L1 k,1 1 �y ficiVocfici
ez) Le 04. Vikc, L.,-4&Ica_ A-- Mi )
I Se >J a c ;-
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.
Ldesq-
) 01, A s° e-r - i ee. 05 A yek rya nt_c e e
or,,,, A- ja. a cis
./.11.e- b - t Q A c.i 144-e$ ' i� c f eceI- Ooz-
T � J� N
e-% i2 t Sc.� .fn n1 cVa. t� -(11 DP ,�,) dt�i2. Q- 0 e 7oVeftts3
n
Al v')�1��j..
Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
1