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

estionsestions onon above,above, pleaseplease aa CityCity Clerk,Clerk, HelenHelen Spencer,Spencer, atat 833833 - - 95099509 oror thethe CityCity HallHall TDDTDD # # 833833 - - 99259925 INFORMATION INFORMATION BELOWBELOW FORFOR USEUSE ONLYONLY BYBY THETHE CITYCITY AppointedAppointed to:to: DateDate ofof originaloriginal appointment:appointment: LengthLength ofof Term:Term:  0311312009 11: 40 8508843988 JOHN DAVIS CAI - HURL PAGE 01 try - ••. -. ,. ••• Ul I i Ur rUK i WAL I UN LitA(; H APPLICATION TO SERVE On City Agencies, Authorities, Boards, Commissions or Committees Reference: Codified Ordinances of Fort Walton Beach - Section 2. 60) Name. 4* b0 Home address: 9R!. {- Home phone: a6J- Rtg -g0ct t N 0 E -mail: Cok Occupation: w Business phone: 1. Brief Resume of Education and Experience AM a,.ki 66A - Mcvke4,& / ALXjUe_<q, QW& J -- ti, 2. What options 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 Board7 cW 40 L.i- t S ? J V oJU 6. Until you ae selected for thb Board of yourchoicemay we submit your ppliiccati0 when vacancies occur rather than ccontacting you? YES X NO, I wish to be contacted first. 7. Would you consider serving on another Board other than the one you selected above? ----- Other Board(s) in which you would be interested YES __ X. NO 1 am a resident of the City: YES NO * I HAVE BEEN a resident for years own property in the CRA District: YES NO _ ** i work in the CRA District. YES NO I am a U.S. citize : Y S NO "'" I am a registered voter: YES NO SIGNATURE DATE_ _ 311-3 NOTE: Application effective for ONE YEAR from date of submission. If 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:  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 : SACRED X- PRESSIONS CONTROL NUMBER : 0006576 LOCATION ADDRESS : 134 MIRACLE STRIP PKY SE LIC NBR/ CLASS : 09- 00007226 SERVICES ISSUE DATE September 09, 2008 EXPIRATION DATE: September 30, 2009 LICENSE FEE 126. 00 ADD'L CHAGE 0. 00 PENALTY 0. 00 TOTAL 126. 00 RESTRICTION COMMENTS ISSUED BY CITY OF FORT WALTON BEACH r  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) I,.;:, i lam- .-. Name: 1 l 8voc-, WS Home address: " 41k e Home phone: 3 3 Occupation: ® 41 1. Brief Resume of Education and Experience 2. What options would you initiate if appointed? 3. How you would address issues if appointed CHECK ANY ONE OF THE FOLLOWING please see other side of application for a brief description of duties 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) roe or work in the district 4.4. DoDo anyany circumstances circumstances / / conditionsconditions existexist whichwhich maymay inhibitinhibit youryour abilityability toto bebe totallytotally objective?objective? _ _ NONO YESYES IfIf yes,yes, explain:explain: 3.3. WhatWhat specialspecial qualificationsqualifications dodo youyou feelfeel youyou willwill bringbring toto thisthis Board?Board? PLC=PLC= ( ( 33 6.6. UntilUntil youyou areare sese forfor thethe BoardBoard ofof youryour choice,choice, maymay wewe submitsubmit youryour application application whenwhen vacanciesvacancies occuroccur ratherrather thanthan contactingcontacting you?you? YESYES NO,NO, I wishwish toto bebe contacted contacted first.first. 77 WouldWould youyou considerconsider servingserving onon anotheranother BoardBoard otherother thanthan thethe oneone youyou selectedselected above?above? YESYES _ _ NONO OtherOther Board(Board( s)s) inin whichwhich youyou wouldwould bebe interestedinterested I amam aa residentresident ofof thethe City:City: YES_YES_ NONO _ _ I HAVEHAVE BEENBEEN aa residentresident forfor 3— 3— yearsyears I ownown propertyproperty inin thethe CRACRA District:District: YESYES CLCL NONO I workwork inin thethe CRACRA District:District: YESYES xx NONO amam aa U.U. S.S. citizen:citizen: YESYES V.. V.. NONO *** *** % % bb- -