Fort Walton Beach Council agenda — 04-14-09 regular — reading text

NONO YESYES 4.4. DoDo anyany circumstances/circumstances/ conditionsconditions existexist whichwhich maymay inhibitinhibit youryour abilityability toto bebe totallytotally objective?objective? IfIf yes,yes, explain:explain: 3.3. 9191 UntilUntil youyou areare selectedselected forfor thethe BoardBoard ofof youryour choice,choice, maymay wewe submitsubmit youryour applicationapplication whenwhen vacanciesvacancies occuroccur ratnerratner tnantnan contacung contacung youyou YESYES __) __) CC NO,NO, II wishwish toto bebe contactedcontacted first.first. 7.7. WouldWould youyou considerconsider servingserving onon anotheranother BoardBoard otherother thanthan thethe oneone youyou selectedselected above?above? YESYES )_ )_ NONO ( ( 0000 OtherOther Board(Board( s)s) inin whichwhich youyou wouldwould bebe interestedinterested I amam aa residentresident ofof thethe City:City: YESYES NONO * * I HAVEHAVE BEENBEEN aa residentresident forfor yearsyears NONO ** ** I workwork inin thethe CRACRA District:District: YESYES NONO I ownown propertyproperty inin thethe CRACRA District:District: YESYES I amam aa registered registered voter:voter: YESYES NONO SIGNATURESIGNATURE DATEDATE WW NOTE:NOTE: ApplicationApplication effectiveeffective forfor 0404 YY fromfrom datedate ofof submission.submission. # # 833833 - - 99259925 - - 95099509 oror thethe CityCity HallHall TDDTDD IfIf youyou havehave anyany questionsquestions onon thethe above,above, pleaseplease callcall thethe CityCity Clerk,Clerk, HelenHelen Spencer,Spencer, atat 833833 iNMRMOTioNiNMRMOTioN BELOWBELOW FORFOR USEUSE ONLYONLY BYBY THETHE CITYCITY Appointed Appointed to:to: DateDate ofof originaloriginal appointment:appointment: LengthLength ofof Term:Term: Date(Date( s)s) re-re- appointed:appointed:  BUSINESS TAX RECEIPT / ADMINISTRATIVE FEE CITY OF FORT WALTON BEACH, FLORIDA 107 MIRACLE STRIP PKY., SW P O BOX 4009 FORT WALTON BEACH, FL 32549 -4009 BUSINESS NAME : BAREFOOT WEDDINGS CONTROL NUMBER : 0005886 LOCATION ADDRESS : 230 MIRACLE STRIP PKY SE LIC NBR/ CLASS : 09- 00006439 SERVICES ISSUE DATE August 04, 2008 EXPIRATION DATE: September 30, 2009 LICENSE FEE 126. 00 ADD'L CHAGE 0. 00 PENALTY 0. 00 TOTAL 126. 00 RESTRICTION COMMENTS A ISSUED BY CITY OF FORT WALTON BEACH  CITY OF FORT WALTON BEACH APPLICATION TO SERVE On City Agencies, Authorities, Boards, Commissions or Committees Name: Home address: Home phone: _ Occupation: 1. Brief Resume of Education and Experience us A) 3. How you would address issues if CHECK ANY ONE OF THE FOLLOWING nleasp Spp nthpr nirlp of anniicatinn fnr a hripf dpccrintinn of rhitipc BEAUTIFICATION COMMITTEE/ FIRE FIGHTERS' RETIREMENT POLICE OFFICERS' TREE BOARD FUND RETIREMENT FUND must be a resident ) must be a resident) BOARD OF ADJUSTMENT FWB HOUSING AUTHORITY VISION PLAN STEWARDSHIP must be a resident) COMMITTEE citizen -at -large must be a resident) CODE ENFORCEMENT BOARD HISTORIC SITES & ADVISORY WATERFRONT COMMITTEE must be a resident) BOARD COMMUNITY REDEVELOPMENT MUNICIPAL PLANNING BOARD AGENCY must be a resident for 2 yrs and must be a City resident, own a registered voter) Property or work in the district 4.4. DoDo anyany circumstancescircumstances / / conditions conditions existexist whichwhich maymay inhibitinhibit youryour abilityability toto bebe totallytotally objective?objective? NONO YESYES IfIf yes,yes, explain:explain: 3.3. WhatWhat specialspecial qualifications qualifications dodo youyou feelfeelYouYou wil wil bringbring toto thisthis a.a. 11AJAJ r> r>_ __ __ _. . nn. _ . ___ 6.6. UntilUntil y9petey9pete selectedselected forfor thethe BoardBoard ofof youryour choice,choice, maymay wewe submitsubmit youryour application application whenwhen vacanciesvacancies occuroccur ratherrather thanthan contacting contacting you?you? YESYES NO,NO, I wishwish toto bebe contacted contacted first.first. ss 7.7. yy WouldWould youyou considerconsider servingserving onon another another BoardBoard otherother anan thethe oneone ouou sese ectedected above?above? YESYES NONO OtherOther Board(Board( s)s) inin whichwhich youyou wouldwould bebe interestedinterested d,. d,. iSiS mm I amam aa residentresident ofof thethe City:City: YESYES OO* * I HAVEHAVE BEENBEEN aa resident resident forfor yearsyears I ownown propertyproperty inin thethe CRACRA District:District: YESYES NONO V,'V,'**** I workwork inin thethe CRACRA District:District: YESYES NONO aa. . SS. itiiti- - YESYES NONO * ** * ** I amam aa registered registered voter:voter: YESYES V_"" V_""NONO SIGNATSIGNAT , , RERE DATEDATE °- °- NOTE:NOTE: Application Application ectiveective forfor fromfrom ateate ff submission.submission. IfIf youyou havehave anan