Fort Walton Beach Council agenda — 11-22-05 ‎(regular)‎ — reading text

V NO _ * I HAVE BEEN a resident for 3 r' years 1./ I own property in the CRA District: YES ~ NO ~ .. I work in the CRA District: YES NO V I~ registered voter. YES ~ o_ 7' SIGNATURE _ ~~ TE: Application effective for ONE YEAR from date of submission. DATE prS" 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 of Term: Date( s) re- appointed:  CITY OF FORT WALTON BEACH APPUCATlON TO SERVE r-\ On C~ ncies, Authorities, Boards, Commissions or ~ mittees Reference: Codified Ordinances of Fort Walton Beach - Section 2-60) N.~: ~ r~ ft~<i&~ J:- ~~ itome address: '=' ~ L t U:>~- - ~ ~~. E- mail:' 1m. phon.: ~":RO- eA. ' Busine ccupatlon: ~ phone: 0 t:. ~ .. ,\ 2., VV~ options would you initiate if~ ppointed? ~ ~ , , 0.... '\ !. $,~ LDotY.L. ~. b6d.~1-. t.. ~_ 3. How you would address issues if appointed "" t c... 1, \ \ Ju.~... 1tu. o...~ u.. So'"-'- ~ ~ Ja~ ~. w. , CHECK ANY ONE OF THE FOLLOWING olease see other side of aoolication for a brief description of duties BEAUTIFICATION COMMliTEE * 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) , - ( must be a resident for 2 yrs and a registered voter) CODE ENFORCEMENT BOARD GOLF CLUB ADVISORY * VISION PLAN STEWARDSHIP must be a resident) COMMliTEE COMMITTEE lcitizen- at- Iarge must be a resident) COMMUNITY REDEVELOPMENT HISTORIC SITES & ADVISORY AGENCY BOARD must be a City resident, own property or work in the district) 4. Do any circumstances/conditions exist which may inhibit your ability to be totally objective? '" NO YES If yes, explain: 3. Wha spe~ al qualifications do you feel 0 .. v.. r ~ 6. Until you are selected for the Board of your choice, may we submit your application when vacancies occur rather than contacting you? J.. 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 I am a resident of the City: YES ~ NO _ * I HAVE BEEN a resident for ~ 4 vears NO ~ I own property in the CRA District: YES - A- NO - I work in the CRA District: YES I am !it registered voter: YES l NO _ SIGNATURE ~ &. c,,~ \J1t DATE ().\ ~ d-coS OTE: Application effective for ONE YEAR from date of submission. 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 of Term: appointed: Date( s) re-  CITY OF FORT WALTON BEACH On o APPUCATION TO SERVE Authorities, Boards, Commissions or Committees O. City Agencies, Reference~ c ified Or ' nances of Fort Walton Beach - Section 2-60) aME ADDRESS C> 0 - S CCUPATION A.1lL,U1-7 fIlC.- 1 HOME PHONE '? J3tr ~~... l~ Q..... S" E- MAIL ~ 1. Brief Resume of Education and Experience tJl'i.. U'; h1j.. s"1ta1t.~ oP- AItJ:4-( HILt." 1ofltfL IqL{7 I'{ 1'c.2JJ4. 1(L,IA/(,- AflPH. ~~ J\l~ C A-~ LI"~ rl., rtsrT'f 5rt.D 10 yt€ 4"-( P(l/ 4# 2. What options would you initiate if appointed tl' ' P1l.oF 1(~ Pu6UI r? 5IOAJL D'L5I& tJ r- vlolJw(,~ 3. State how you would address issues if appointed k L 0(, 4-- 1 L () J7r IJl... (. ()/. J S ,.~ ~ ~ 7 ~D J..) CHECK ANY ONE OF THE FOLLOWING Please ... other side of. lC8tion for. descrl of duties Beautification Committee Fire Fighter's Retirement Fund Police Officer's Retirement Fund must be a resident must be a resident) Board of Adjustment FWB Housing Authorit must be a resident) must be a resident) Code Enforcement Board must be a resident) Historic Sites Board m--.. JAMES W. MATTERN. JR. U.. AACOOO264 ARa-JITECT Community Redevelopment Performing Arts Committ. 243-9158