HomeMy WebLinkAboutRenshaw Application 19871. Name
2. Home Address:
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CITY OF CAPE CANAVERAL
QUALIFICATIONS FOR SERVING ON CITY BOARDS.
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Home Telephone: -7E?)
3. Business: t.c. (<34(4 L, Business Telephone: - 2.C) 0
4. Office Address: 8) o
5, Brief Resume of Education and Experience: ,72--),c ( -0_ C 4
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NA A n( A 1- " '77- tA ,!--,. ,0 A, V (-0 &lel L... N/1
6. Are you a registered Voter? Yes 1-77- No
7. Resident of City for 12 months or longer?
8. Do you hold a public office? Yes
9. Are you employed by the City?
Yes No
No
Yes No
10. At the present time, do you serve on a City Board? Yes No
11. Name of City Board You Are Interested In Serving On: (Specify Preference)
• ast, 4, 3rd, etc.)
Beautification Board
Board of Adjustment*
• Code Enforcement Board*
Library Board
1 Planning and Zoning Board*
a, Recreation Board
12. Qualifications to serve on this Board:
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13. Would you consider serving on another Board other than the one you
selec,-. bove?
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Signature:
COA4t JiLL
No
Date 42 A 7
NOTE: (1) - Applica effective for one ye r from date of completion.
(2) If you ha-- any questions on the above, please call the
office of City Clerk, Telephone 783-1100
*Financial Disclosure Form must be completed each year, prior to July 15,
by members of these Boards.
FOR OFFICE USE ONLY:
Appointed to Board on
Term to Expire
(Date)
(Date)
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