McCarthy, Carolyn CARAC 6-9-10 CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(Ai)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
V Cultural Arts and Recreation Advisory Committee
D ATE,) � In U 1 26 I 0 APPLICANT'S NAME: OA l/�
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ADDRESS: 2 % (11 111( 6'elv, W -I, 1\ * &VIC PyaCt), 2-2-53
DAYTIME PHONE: O"l i*fl V) EVENING PHONE: "f o Li I �'D�g 7
E-MAIL ADDRESS: LV0 pwcav'1"''l e FAX:
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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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Please return completed form to
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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