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

19= 1 On City Agencies, Authorities, Boards, Commissions or Committees Reference: Codified Ordinances of Fort Waaon Baeon - Section 2E0) Gen.... 0.nNI P. t. _ Homephone: 1. Brief Resume 2. at op ions would you inflate if appointed? how nT it L t$ S w '$ Jorw p„t„ QLAA%1, e. i o ¢ 1` yy , { n tyy t•.[.(r, 3 How yhr, ouwould w8. addlessnas3sifappoirrled cc CHECK ANY ONE OF THE FOLLOWING please see other side of aoolication for a brief descrinfion of duties BEAUTIFICATION COMMITTEEI ECONOMIC ADVISORY GROUP MUNICIPAL PLANNING BOARD cEnSv. nn TREE BOARD citizen -at -large must be a resident) x must be a resident for 2 yrs and a r istered voter 00 seem BOARD OF ADJUSTMENT FIRE FIGHTERS' RETIREMENT FUND must be a resident) POLICE OFFICERS' RETIREMENT FUND must be a resident) mCcrn aa CODE ENFORCEMENT BOARD must be a resident) FWB HOUSING AUTHORITY must be a resident) WATERFRONT COMMITTEE uNCD COMMUNITY REDEVELOPMENT HISTORICSITESB MM AGENCY STRUCTURESADVISORYBOARD must be a City resident, own roe or work in the tlishict c0 4.4. 3.3. 6.6. DoDo anyany clrcumstanceslconditions clrcumstanceslconditions existexist whichwhich maymay inhibitinhibit youryour abilityability toto bebe totallytotally objective?obj--)_ective? --)_ Ifyes,Ifyes, explain:explain: WhatWhat gRgQalgRgQal qualificationsqualifications gogo youyou NONO _ _ YESYES UntilUntil youyou areare selectedselected forfor thethe BoardBoard ofof youryour choice,choice, maymay wewe submitsubmit youryour application application whenwhen vacancies vacancies occuroccur ratherrather thanthan contactingcontacting you?you? YESYES K_K_ NO,NO, I wishwish toto bebe contactedcontacted first.first. Mdo 0q0q QQ adnoando UU cc drdr DD 7.7. WouldWould youyou considerconsider servingserving onon anotheranother BoardBoard otherother thanthan thethe oneone youyou selectedselected above?above? _ _ YESYES kk NONO OtherOther Board(Board( s)s) inin whichwhich youyou wouldwould bebe interestedinterested I amam aa residentresident ofof thethe City:City: YESYES -/_, -/_, NONO • • 1 HAVEHAVE BEENBEEN aa residentresident forfor DD yearsyears cvzE I ownown propertyproperty inin thethe CRACRA District:District: YESYES Y,Y, NO_NO_° ° I wooswoos inin thethe CRACRA DistnctDistnct YESYES _ _ NONO xa I amam ( ( U.U. S.S. citizen:citizen: YESYES —.' —.' hehe NONO— — I amam aa registeredregistered voter:voter: YESYES XX NONO SIGNATURESIGNATURE /- /-