Fort Walton Beach Council agenda — 01-23-2007 regular agenda — reading text

must be a resident) Committee citizen- at- Iarge appointment must be a resident) Community Redevelopment Performing Arts Committee X Agency Jst be a City resident, CMm property in the CRA district or work in the CRA district) X NO YES 4. Do any circumstances/ conditions exist which may inhibit your ability to be totally objective? If yes, Explain: 1 have been nvol ved l. l. n 5. What special qualifications do ' you bring to this Board? feel you will community problem solving, planning, and decision makl.ng l.n Chicago, Nashville Bl.rml.ngharn, Vl.dall.a GA, and Bloomington IL on a variety of levels. 6. Until you are selected for the Board of your choice, may we submit your application when vacancies occur rather than contacting YES X NO, I wish to be contacted first. you? 7. Would YQU consider serving on another Board other than the one you selected above? possi'1ffBe NO Other Board in which you would be interested I AM NOT _ resident; * a J AM A x--- resident of the city; I HAVE BEEN a resident for 4 years I AM NOT a registered voter I AM X a registered voter J own property in the CRA District YES _ NO ~ I work in the CRA District YES -- NO K... SIGNATURE DATE Ill/ dAd-/; l/).tJ/('" NOTE: Application INFORMATION BELOW FOR USE ONLY BY THE CITY OF FORT WALTON BEACH 3 Appointed to: Date of original appointment: Length of Term: Ite( s) re- appointed: If you have any questions on the above, please call the City Clerk, Helen Spencer, at 833- 9509 or the City Hall TDD # 833- 9925 Updated 3- 7- 03  to /~ CZ 1 Up\.( occ. CITY OF FORT WALTON BEACH I In APPUCATlON TO SERVE On City Agencies, Authorities, Boards, Commissions or Committees Reference: Codified Ordinances of Fort Walton Beach - Section 2- 80) t>>/~ ILt / Vld-5f } tJrL 3. Howyouwouldaddressissuesifappointed t& 5~ V"",^ ~ /!. tv'/ew all (~ h ~ tJ'r' h 1/f't. dUI5' ), IfIl~ I CHECK ANY ONE OF THE FOLLOWING Dlease see other side of aDDllcatlon for a brief descrlDtlon of duties BEAUTIFICATION COMMITTEE .. FIREFIGHTERS' RETIREMENT .. POLICE OFFICERS' FUND RETIREMENT FUND must be a resident) ( must be a resident) BOARD OF ADJUSTMENT .. FWB HOUSING AUTHORITY .. MUNICIPAL PLANNING BOARD must be a resident) - ( must be a resident for 2 yrs and a registered voter) CODE ENFORCEMENT BOARD GOLF CLUB ADVISORY .. VISION PLAN STEWARDSHIP must be a resident) COMMITTEE COMMITTEE citizen-at-larae must be a resident) COMMUNITY REDEVELOPMENT HISTORIC SITES & ADVISORY j .. AGENCY must be a City resident, own BOARD property or work in the disbict) 4. Do any circumstances/conditions exist which may Inhibit your ability to be totally objective? V-- NO _ YES If yes, explain: 3. 6. Until you are sel~ for the Soard of your choice. may we submit your application lNtIen vacancies occur rather than contacting you? YES V NO. 1 wish to be contacted first. / 7. Would you consider serving on another Soard other than the one you selected above? _ YES ~ NO . other Board( s) in which you would be interested ama residentoffhe City: YES / NO _ .. I HAVE BEEN a resident for y~ years NO _ in the CRA District: YES / NO ** I wor;in the CRA District YES / a...__ r. YEs..L:~ SIGNATURE I ;::/. 29/ 0S;- NOTE: Appfication effective for ONE YEAR from date of submission. If you have any questions on the above, please call the City Clerk, Helen Spencer, at 833-9509 or the City Hall TDD '# 833- 9925 INFORMATION BELOW FOR USE ONLY BY THE CITY A ,. . ~ I ApPOintedto:~ of._' Da.. CjctJ,- ' 1," 7/ 07 appo' ntment '/' LenglhofTem,,( ~~ puacv . I Jan 03 2007 8: 58AM RICH ASSOCIATES, INC 12/ 27/ 2a66 89: 51 2483533830 18508339926 p. 2 tORi WALTON BEACH PAGE ElllEn CITY 01'"FO!f1' WALTON BEACH APPUCATlON TO S~ RV& On City AgelC\ ies. Authorities, 9oarcls. COmmissions Dr CommttWes Aefenenoe: Codi~ D OrdInance' at Fort WI!1On 8each. Sec{lon 2-40) Nsme: .. . 1~ E~ I: ~. n ow; ~:;~,~~~