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

GOLF CLUB ADVISORY .. VISION PLAN STEWARDSHIP must be a resident) COMMITIEE COMMITTEE citizen- at- Ian:Je must be a resident) COMMUNITY REDEVELOPMENT HISTORIC SITES & ADVISORY AGENCY BOARD' X must be a City resident, own DroDertv or work in the district) 4. Do any circumstances/ conditions exist which may inhibit your ability to be totally objective? X NO YES If yes, explain: 3. What special qualifications do you feel you will bring to this Board? t< V"~ I ~ ^. o':! . '" OM.,,/ e"" ;:>, P.6&- TY ( 5 'rq ; 2A-,,, v7 t J/ /! ke// V/j) 1 ( tv~ ;:;./t" P , eljh} ./ f1V"/ 6:... M'- or rV7' v<<~i> 6- vtfU.- o rrY]~ 5, rtZ- J.6'_c r-- Lfh,~. i> 0';</ ~~/;z.....,- IY/6.rn 5!LiZ.. v'-- 0=/ 5: 1""" 11 " Kfl- BOA",zP / f"} 6- mB6'. tr RtP;:"; qR/, k'T/ t: f' rE /" v" tl;Ci' 6: ~/:;/; l"/ re roR.~/ . k-.-+ t. VJ, vJoJ 7I?>. s:. 1'1~ f' d.. 6. Until you are selected for the Board of your choice, may we submit your application when vacancies occur rather than contacting you? z. YES NO, I wish to be contacted first. 7. Would you consider serving on another Board other than the one you selected above? >< YES NO Other Board( s) in which you would be interested t3.EA t/ T) r:CA- c.d. .:; '" "7";/' c t:-, I am a resident of the City: YES _ NO _ .. I HAVE BEEN a resident for years I own property in the CRA District: YES ~ NO ** I work in the CRA District: YES >< NO I a.r,a registered voter: YES ;<. n NO_ r'"'- ro, /"\ /) .' " C, SIGNATURE r7.~:;(/ IC. t7- I/:; l~..:. i.~/ DATE r (1./.; 1-# .() 7 I JTE: Application effective for ONE YEAR fr6m date of submission. J 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 Appointed to: Date of original appointment: Length ofTerm: Date( s) re- appointed:  CITY OF FORT WALTON BEACH APPLICATION TO SERVE On City Agencies, Authorities, Boards, Commissions or Committees Reference: Codified Ordinances of Fort Walton Beach - Section 2-60) Name: Po U C'I \cA...- 5 ' k~ f.:) me address: ~ Jme phone: ~ t> - ~ ~-' 3" t; . t' E- mail: Occupation: ~.() i! rf!... t?- r 3. CHECK ANY ONE OF THE FOLLOWING please see 0 th er ' SI d e 0f r fIon fora b'fiefd escnp1tj on 0 fd ules appllca f BEAUTIFICATION COMMITTEE * FIRE FIGHTERS' 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) *, o ( 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- Iarge must be a resident) II' * COMMUNITY REDEVELOPMENT HISTORIC SITES & ADVISORY V AGENCY