Fillable Town of Fort Myers Beach Advisory Boards and (Town of Fort Myers Beach)

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Town of Fort Myers Beach Advisory Boards and (Town of Fort Myers Beach)

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Town of Fort Myers Beach
Advisory Boards and Committees Application
Complete one form for each application/committee appointment. Your application will be a
public record subject to disclosure on request.
Please type or print clearly.
Today’s Date:
Name:
Last First Middle initial
Telephone Number:
Email Address:
Home Address:
Mailing Address
(
if different from home address):
Are you currently serving on any of the Town’s committees? Yes No
If yes
, which committee(s)?
If yes, when is your term expiration?
I am applying for appointment to: (Check one)
Anchorage Advisory Committee
Audit Committee
Bay Oaks Recreational Campus Advisory Board
Community Resource Advisory Board
Cultural and Environmental Learning Center Advisory Board
Historic Preservation Advisory Committee
Local Planning Agency
Marine Resources Task Force
Nuisance Abatement Board
Public Safety Committee
Have you been convicted of a felony, an offense involving moral turpitude while
Yes No
Yes No
in office?
Do you have unpaid fines or liens due the Town?
Are you a registered voter within the Town’s jurisdiction?
Page 1 of 2
Yes No
11/05/2020
Page 2 of 2
Office Use Only:
Appointed:
Yes _____ No _____ DATE: _____________
Are you a resident within the Town’s jurisdiction? Yes No
Are you an owner of real property within the Town’s jurisdiction? Yes No
Are you currently serving on a board, authority, committee or commission for another
governmental agency? Yes No
If yes, what board, etc., and since when?
Why are you seeking appointment to this board or committee?
Community Involvement:
IInterests / Activities:
You may attach a resume in addition to the above information.
Do you qualify for Special Exemptions per § 119.071(4)(d)3., F.S.
Yes No
If yes and you are appointed, you will be asked to fill out Public Records Exemption Request
form and return to the Town.
I swear or affirm that all information on this form is true and accurate.
Signed Date
Please return this form to the Town Clerk’s Office, Town of Fort Myers Beach, 2525 Estero Boulevard,
Fort Myers Beach, FL 33931 www.fmbgov.com
________________________________________________________________________________________
11/05/2020
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Town of Fort Myers Beach Advisory Boards and (Town of Fort Myers Beach)

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Completed 21 January 2021

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