Fort Walton Beach Council agenda — 08-09-11 regular part 2 of 2 — reading text

Completed 07/ 27/2011 10: 33 AM City Manager Completed 08/ 01/ 20114:06 PM City Council Pending Packet Pg. 199  CITY OF FORT WALTON BEACH 13. 2.. APPLICATION TO SERVE On C., Agencies, Authorities, Boards, Commissions or committees Reference: Codified Ordinances of Fod Walton Beach - Section 2 -60) OWING nleam ron nr6n. e: Au .. i ennl:.... no.., CHECK ANYONE OF THE FOLLOWING e....,' Ad d- -- A- -; . c0dE BEAUTIFICATION COMMITTEE FIRE FIGHTERS' RETIREMENT FUND must be a resident POLICE OFFICERS' RETIREMENT FUND must be a resident QaQN6a6 mm acmE 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 N6N6uE must be a resident) COMMITTEE COMMITTEE MM dfizen- at -large must be a residen0 MM COMMUNITY REDEVELOPMENT HISTORIC SITES & ADVISORY AGENCY BOARD cC mustmust bebe aa CityCity resident,resident, ownown propertyproperty oror workwork inin thethe districtdistrict nn 4.4. DoDo anyany circumstances circumstances / Ifyes,Ifyes, expiain:expiain: / conditionsconditions existexist whichwhich maymay inhibitinhibit youryour abilityability toto bebe totallytotally objective?objective? NONO _ _ YESYES QQ yy 3.3. WW tt specialspecial qualificationsqualifications dodo yy ufeelufeel ypuypu willwill bdngtothibdngtothi 99 C fnfn e. Un forth oard of of your your choice, choice, may may we we submit submit your your application application when when vacancies vacancies occur occur rather rather than than contacting contacting you? you? m areare soksok YES _ forth oard N O, 1 wish to be contacted first. EE 7.7. WouldWould youyou considerconsider servingserving onon anotheranother BoardBoard otherother thanthan thethe oneone youyou selectedselected above?above? _ _ VV ES NO tmtm Other Soard(s) in which you would be interested QQ I am a resident of the City: YES NO * I HAVE BEEN a resident for ' years I own property in the CRA Distdct YES NO _ " I work i e CRA District: YES _ NO _ I am a registered voter. YES NO SIGNATU !/ DATE NOTE: Application egective ' ONE YEAR from date of submission. If you have any questions r the above, please call the City Clerk, Helen Spencer, at 833 -9509 or the City Hall TOO # 833 -9925 Appointed to: Date of origin Packet Pg. 200  CITY OF FORT WALTON BEACH APPLICATION TO SERVE