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HomeMy WebLinkAbout2007 07 09 Regular 602 Advisory Boards/Committee Appointments COMMISSION AGENDA ITEM 602 Informational Consent Public Hearings Regular X July 9.2007 Regular Meeting M; / ~t. Authorization REQUEST: The City Clerk requests that Members of the City Commission (depending on the applicable Advisory Boards and Committees) make Appointments/ Reappointments related to the Terms of Office which will be expiring in July 2007 - specifically regarding a Member of the Beautification Of Winter Springs Board; the Planning And Zoning Board/Local Planning Agency; and the Tuscawilla Lighting and Beautification District Advisory Committee. PURPOSE: The purpose of this Agenda Item is for Members of the City Commission (depending on the applicable Advisory Boards and Committees) to make Appointments/Reappointments for the Advisory Board and Committee Members whose Terms of Office will be expiring in July 2007. CONSIDERATIONS: Currently, the following Appointments/Reappointments for three (3) Advisory Boards/Committees Members remain to be made. The names that are shown with a strikethrough font were recently either Appointed/Reappointed and do not need to be further addressed. CITY OF WINTER SPRINGS, FLORIDA CITY COMMISSION REGULAR MEETING - JULY 9, 2007 REGULAR AGENDA ITEM 602 PAGE20F4 The Terms of Office for the following individuals will be expiring in July 2007: BEAUTIFICATION OF WINTER SPRINGS BOARD: . Lorry Roere Has Requested Te Be Reappointed [Scat One Appointment] . Ethel Beecher Does Not Wish To Be RetlJ9[Jointed [Scat Three Appointment] . Denise Ritchey - Does Not Wish To Be Reappointed - [Seat Five Appointment} The Beautification of Winter Springs Board is a seven (7) Member Board, which typically meets on the second Wednesday of each month, beginning at 7:00 p.m. Their Term of Service is for three (3) years. PLANNING AND ZONING BOARDILOCAL PLANNING AGENCY: . Linda Tillis - Does Not Wish To Be Reappointed - [Seat Two Appointment} . Bill Poe Has Requested To Be Reappointed [Seat Four Appointment] The Planning and Zoning Board/Local Planning Agency is a five (5) Member Board, which typically meets on the first Wednesday of each month, beginning at 7:00 p.m. Their Term of Service is for three (3) years. TUSCA WILLA LIGHTING AND BEAUTIFICATION DISTRICT ADVISORY COMMITTEE: . },{ary Brook Has Requcsted To Be Rcappointed [Scat Onc Appointment] . Brantley Tillis - Does Not Wish To Be Reappointed - [Seat Five Appointment} Also to note, the following Appointment needs to also be made, as the individual who previously held this Seat, is no longer serving on this Committee: . Seat previously held by Helen Baker - [Seat Three Appointment} The Tuscawilla Lighting and Beautification District Advisory Committee is a five (5) Member Committee, which typically meets on the third Wednesday of each month, beginning at 7:00 p.m. Their Term of Service is for three (3) years. Any Appointments/Reappointments that are not made at this Meeting, will be placed on subsequent Agendas, until the vacancies have been filled. CITY OF WINTER SPRINGS, FLORIDA CITY COMMISSION REGULAR MEETING - JULY 9, 2007 REGULAR AGENDA ITEM 602 PAGE30F4 RECOMMENDATION: Regarding Terms of Office that are up this July of 2007, two (2) City Commissioners are requested to make their respective Appointments/ Reappointments regarding the following Advisory Board and Committee Members that are noted in this Agenda Item and as designated below - with consideration that Advisory Board and Committee Members will be needed for quorums for upcoming Meeting. Please see the following names and respective Seats and note that not everyone may wish to be reconsidered for Reappointment: Appointment To Be Made By Commissioner Rick Brown: . Linda Tillis - Planning And Zoning Board/Local Planning Agency - Does Not Wish To Be Reavvointed Appointments To Be Made By Commissioner Joanne M. Krebs: . Denise Ritchey - Beautification of Winter Springs Board - Does Not Wish To Be Reapvointed . Brantley Tillis - Tuscawilla Lighting and Beautification District Advisory Committee - Does Not Wish To Be Reappointed Additionally, there are two (2) other vacant Seats: Appointment To Be Made By Commissioner Donald A. Gilmore: . Tuscawilla Lighting and Beautification District Advisory Committee - Seat previously held by Helen Baker - [Seat Three Appointment} Appointment To Be Made By Commissioner Joanne M. Krebs: . Oak Forest Wall and Beautification District Advisory Committee - Seat previously held by Alice Louise Allen - [Seat Five Appointment} ATTACHMENTS: A. Copy of one letter sent to one (1) Advisory Board/Committee Member and a copy of one (1) Certified letter sent to one (1) Advisory Board/Committee Member - whose Terms of Office will be expiring soon. B. Copy of any Letters/Applications from current Advisory Board/Committee Members that have been received by the Office of the City Clerk, pertaining to Attachment "A" regarding Appointments/Reappointments that still need to be made. CITY OF WINTER SPRINGS, FLORIDA CITY COMMISSION REGULAR MEETING - JULY 9, 2007 REGULAR AGENDA ITEM 602 PAGE 4 OF 4 C. Copy of a letter and related Application from a current Advisory Board Member who wishes to be considered for Appointment to another City Advisory Committee (Denise Ritchey). D. New Applications from citizens that have been received during this calendar year, which you may wish to consider (in order of date received). E. Additional Applications from citizens that were received last year, which you may also wish to consider (in order of date received). COMMISSION ACTION: ATTACHMENT "A" CITY OF WINTER SPRINGS, FLORIDA 1126 EAST STATE ROAD 434 WINTER SPRINGS, FLORIDA 32708-2799 TELEPHONE: (407) 327-1800 FACSIMILE: (407) 327-4753 WEBSITE: www.winterspringsfl.org April 23, 2007 Mr. Bill Poe 639 Marlin Road Winter Springs, Florida 32708 Dear Mr. Poe: First of all, thank you very much for your devoted service to the City of Winter Springs as one our Advisory Board Members. Now, as you probably are aware, your Term of Office as a Member of the City of Winter Springs' Planning and Zoning Board/Local Planning Agency expires in July of this year. I am currently in the process of notifying all Advisory Board Members, along with the Mayor and City Commission as to which Terms of Office will expire this year. If you are interested in being considered for Reappointment, please provide both a letter of intention and complete the attached Application (which is needed to update our records and is a requirement per the passage of Ordinance 2001-49). Both documents should be forwarded to my attention, prior to Friday, May 25, 2007. Shortly thereafter, I will then forward copies to the Mayor and City Commission for their review and consideration. Should you prefer to not be considered for Reappointment, then please forward this information, in writing, to my attention prior to Friday, May 25,2007. If! may be of further assistance, please feel free to contact me at (407) 327-5955. ; ea Lorenzo-Luaces, CMC CitY Clerk COPY: Mayor And City Commission (w/o attachments) File Attachments s. Sharon Hotchkiss )3 Oak Forest Drive inter Springs, FL 32708 U~ NDER: COMPLETE /S SECT/ON COMPLETE THIS SECTION ON DELIVERY l'- CI <0 :<0 Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. Print your name and address on the reverse so that we can return the card to you. Attach this card to the back of the mailpiece. or on the front if space permits. ArtIcle Addressed to: 3. ~ Type E!I' y.rdIIed Mall E1'Reglstered o Insured Mail o Express MaD o Return Receipt for Merchandise o C.O.D. It ~ ,- ~ , Total Postage & Fees _ .' ~ s5' \~ '<'l~\"~ ! ~ ~;~::NA ;9i3--/J;.~--:~;;-;:;:y;a O. Is dellv"'Y address different from item 1? If YES. enter delivery address below: 0 No CITY OF WINTER SPRINGS, FLORIDA Via Certified Mail Delivery 1126 EAST STATE ROAD 434 WINTER SPRINGS, FLORIDA 32708-2799 Telephone; (407) 327-1800 Fax: (407) 327-4753 Website: www.winterspringsft.org May 3, 2007 Ms. Sharon Hotchkiss 903 Oak Forest Drive Winter Springs, Florida 32708 Dear Ms. Hotchkiss: This is a follow-up letter to you regarding the letter previously sent out on May 3, 2007. Again, thank you very much for your service to the City of Winter Springs as one our Advisory Committee Members. As you probably are aware, your Term of Office as a Member of the City of Winter Springs' Oak Forest Wall and Beautification District Advisory Committee expires in August of this year. I am currently in the process of notifying all Advisory Committee Members, along with the Mayor and City Commission as to which Terms of Office will expire this year. If you are interested in being considered for Reappointment, please provide both a letter of intention and complete the attached Application (which is needed to update our records and is a requirement per the passage of Ordinance 2001-49). Both documents should be forwarded to my attention, prior to Friday, June 8,2007. Shortly thereafter, I will then forward copies to the Mayor and City Commission for their review and consideration. ., ~uld you prefer to not. be considered for Reappointment, then please forward this information, in writing, to my attention prior to Friday, June 8, 2007. If! may be of further assistance, please feel free to contact me at (407) 327-5955. COPY: Mayor And City Commission (w/o attachments) File Attachments . ... ATTACHMENT "B " ~. ~ ~ ~ I~ ~. ~~ . l0.. ~ ~ <lS ~ 'I il -""';"'0 W CO i"- . .......... c= -. '<) > ~ ,~~ .. - N 0:0 W N ~w (J ZI >- ~IL W < \LO Z Ow <<, \ S~ o . .. . ~. . . \I . ~ '\i ~- ""~.' ~~~,,;:c-~ ~ liI"'~ :.:a"".. \~-1tt- L --,., /i ~) l"j~, V 0 .1'".: '7nii7 5", F ~, ~../!.. .... wi 11 02 Erie Ct Winter Springs, FL 32708 May 6, 2007 CITY OF W:NTt::R SPRiNGS OFFICE OF THE CiTY CLEF<K Andrea Lorenzo-Luaces City Clerk City of Winter Springs 1126 East State Road 434 Winter Springs, FL 32708-1800 Dear Ms. Lorenzo-Luaces, This letter is to notify you that I do not wish to be considered for reappointment to the Planning and Zoning Board when my term expires in July of this year. I appreciate having the opportunity to serve on the Board, but find that I no longer have the time available to devote to this position. Sincerely, y{~~ Linda Tillis Page 1 of 1 Andrea Lorenzo-Iuaces From: Carol Lallathin Sent: Wednesday, June 06, 20077:42 AM To: Andrea Lorenzo-Iuaces Cc: _City Clerk Department Subject: FW: TLBD Service Here is resignation letter from Brantley Tillis. ~~ Assistant to the City Clerk City of Winter Springs 1126 East S. R. 434 Winter Springs, FL 32708 Phone: 407-327-1800 x- 225 407-327-5961 email: c1allathin@winterspringsfl.org From: btillis@mindspring.com [mailto:btillis@mindspring.com] Sent: Tuesday, June OS, 2007 9:56 PM To: Carol Lallathin Cc: Rande Thompson; Steven Richart Subject: TLBD Service Carol- I need to let you know officially that I do not plan to serve again on the TLBD board after the end of my 3 year term ending in July. Unfortunately, my schedule and time commitments are overbooked. I must say that it has been a pleasure serving on the board and feel that the TLBD is going well and the city staff are doing a great job. I appreciate the efforts of you and my fellow board members. Finally, a special thanks must go to Steven Richart who has done an outstanding job for the city. By the way, I will be out of town the week of the June meeting but plan to make July before my term ends. Thank you. Brantley Tillis 407 -977 -9155 bti lIis@mindspring.com 6/18/2007 ATTACHMENT "C" ~"'"'~ '~.- "".' ,.,_i ......~,.~ ~-.;: -: ;; r~1t~ y 3 1 2007 May 31,2007 CITY OF WINTER SPRINGS OFFICE OF THE CITY CLERK Office of the City Clerk Winter Springs, Florida As previously serving as a member of the BOWS Board, I would like at this time to resign from this position so as to be considered for a position on the TLBC Board. I do this in the understanding that I am unable to serve on both boards simultaneously. Thank you for your time. c'-~~ Sincerely, R--....-'l.,!'!,fiP~"...",. !';f".._. -'f!/' -.~~ t.;_a '"" "_','- " . ~ \~".. ~N' "". - MA y 1 8 ~7 Office of the City Clerk Winter Springs, Florida Cl1Y OF Wli'.r'~~' F.: : ~..,~;' OFFICE OF Thr~ '~:i Y Cc.U,,, It will be my intent to serve for another year on the Beautification of Winter Springs Board, known as the B.O.W.S Advisory Board. Thank you for your time and consideration in this matter. Sincerely, ~ May 14th, 2007 CITY OF WINTER SPRINGS APPLlCA TION FOR APPOINTMENT TO em ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL 1. Name: ~~~~~ ~~-\~..-.~\ Home Address: \ is ~ C'\r...l2.-^.A...U ~ '\c:...- c.~ G Home Telephone:~ (~"=t - ~ L:. S- 0 "t +\ Occupation: ~'^~~~ ~~,~ Business Telephone: LlDI.... ~ l "'L-lc 'Ll1- 2. 3. 4. 5. 8. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: 28. Do you live within the City limits of Winter Springs: (Y) ~(N)_ (Y) /(N)_ \~~. 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. . M_ (N) ~ 4a. 00 you presently serve on any other City of Winter Springs advisory board or committee? (Y).(N) ~ 4b. If yes to 4a, please list each: 5. City ordinance requires that all persons applying (or a Cilyadvisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. 00 you voluntarily consent to having a ~ L standard background check being performed on you by ~s the City of Winter Springs? (Y)_ (N)_ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y)_ (N)~ 6b.lf yes to 6a, please provide relation: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: 2: ....,-.,\ "'. ~~~ ~ ~-",,^::::~<> , <;DAA. D % __ _~~ ."".~ _ .~ ~q....J::' ~ 2. Briefly state any prior experiences in serving on any governmental board or committee: 3. In numerical sequence (1 - most interested), please rank which advisory board or committee you wish to serve:' a. Board of Adjustment Board of Trustees b. c. ~. Beautification of Winter Springs Board d. Charter Review Committee e. Code Enforcement Board f. Districting Commission g. Oak Forest Wall and Beaulification District Advisory Committee h. Planning and Zoning Board/local Planning Agency I. ------ Tuscawil/a Lighting and Beautification District Advisory Committee J. Other: .'Please see attachment for description of the advisory board or committee. . 2 D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian-American ---- Female Hispanic-American Not Known Native American ------ Caucasian DISABILITY NOIKnown Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAwn [SECTION 286.011, FLOR'D~-ST A TUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT'S YOUR SOLE OBLIGATION AND DUTY TO COMPL Y WITH SUCH LAWS. Signature: c.... '~~ ~ ~"- - -.x --""\ ~~ ~ .J Date: Please return tu. City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 . 3 ~ ~:r~~,m'::==:~:=~~~j:f.===:~ =~:::1t: rk~a1d Or oommit% ~~ts~(boud .nd"'!mmi....,n~~,~~ft:P;:~-=':or:oxm: : serv~n a:ard or commIttee oflhe cL s_ILJL~ ~_e ...9__ R_ _~en~ CL! IS o~rwise provided bv stale or federal law: . ill Com Jele a board or committee a commission- 0\-<-' Q) ill W -------ffi---- - ~, -No City of Winter Springs Ordinance No. 2001.49 Page 3 of 5 _ _. ,;; .r:" 'p~ \ ~ ~ krc..--t\-c"'Y ,.. :;. .. :".;". ---_._-----~-_. ATTACHMENT "D" ~ RECEIVED APR 0 9 2007 CITY OF WINTER SPRINGS CITY OF WINTER SPRINGS APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR eB~~ITYCLERK City Code requires prospective and eXisting board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. 4. Occupation: .44e'5- t: rlliRj) ~r;. L{) <:; .?;{7{)6 1. 2. Home Address: 3. 5. Business Telephone: I ~cc1 ~ /~ MIf1SY1c;j ~ 8. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y) V (N)_ (Y)~(N)_ rrhl3iJ/~ 3 2a. Do you live within the City limits of-Winter Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication. of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)_ (N)~ (Y)_ (N) V 4a. 00 you presently serve on any other City of Winter Springs advisory board or committee? 4b. If yes to 4a, please list each: , './ 5, City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. 00 you voluntarily consent 10 having a standard background check being performed on you by the City of Winter Springs? ' 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y)~ (NL~ 6b. If yes to 6a, please provide relation: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: 3. In numerical sequence (1 - most interested), please rank which advisory board or committee you wish to serve:" a. b. 7 c, d. e. / f. Board of Adjustment Board of TTustee's -, Beautification of Winter Springs Boa(d ~ Charter Review Committee j. -L Code Enforcement Board Districting Commission Oak Forest Wail and Beautification District Advisory Committee Planning and Zoning Board/local Planning Agency Tuscawilla Lighting and Beautification District Advisory Committee Other: ~. g. . h. I. "Please see attachment for description of the advisory board or co 2 O. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asia n-American V Female Hispanic-American Not Known ;/ Native American Caucasian DISAB~ITY Not Known V Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KN0WLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODe OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND I . APPOINTED, IT OUR SOLE OBLIGATION AND DUTY TO COMPLY WITH S fi LAWS. Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 J f ADVISORY BOARDS AND COMMITTEES Beautification of Winter Springs Board (B.O.W.S.): This seven (7) member Advisory Board is "empowered and directed to consider and study the entire field of beautification in the city." Regular Meetings are held on the second Wednesday of each month. Board of Adjustment: This is a five (5) member Advisory Board which "shall make recommendations to the city commission to grant any variance or special exception." Currently, Regular Meetings are held "as needed" _ on the first Thursday of each month. Board of Trustees - Employee Pension PIau: This is a five (5) member Advisory Board which "shall administer the city's pension plan pursuant to the provisions contained therein as adopted by the city commission." Regular Meetings are held quarterly, on the last Tuesday of January, April, July, and October. Code Enforcement Board: This is a seven (7) member Advisory Board which after a hearing complete with testimony, issues "fmdings of fact, based on evidence of record, and conclusions of law and shall issue an order affording the proper relief consistent with powers granted herein." Regular Meetings are held on the third Tuesday of each month. Districting Commission: This five (5) member Advisory Commission files a report containing a recommended plan for establishment or adjustment of the district boundaries. By City Ordinance, this Advisory Commission meets every three (3) years. The last Districting Commission met in early 2004. Regular Meetings are held when designated. The next appointments to the Districting Commission will most likely be made in early 2007. Oak Forest Wall And Beautification District Advisory Committee: This five (5) member Advisory Committee "shall review and discuss issues related to the foregoing and other directly related matters of interest to the owners of property within" the Oak Forest subdivision. Regular Meetings are held on the second Thursday of each month. Planning And Zoning Board/Local Planning Agency: This five (5) member Advisory Board recommends to the City Commission "the boundaries of the various original zoning distriets and- appropriate regulations to be enforced therein and any proposed amendments" along with dealing with traffic circulation elements, and the Comprehensive Plan. Regular Meetings are held on the first Wednesday of each month. Tuscawilla Lighting And Beautification District Advisory Committee: This five (5) member Advisory Committee "shall review and discuss issues related to the foregoing and other directly related matters of interest to the owners of property within" the Tuscawilla community. Regular Meetings are held on the third Wednesday of each month. Revised 08/04 ~ ~'~I.:.-r~=~~X~:~~~:U:=:~==: =~:'t: : roam or commi~l ~en,:;(bo"" ",d ~mmi'" )11:~:::n:"i~::'~ected O(:':cinlcd : ~n a:ard or commltteeofthc _tv '_1_ _L_c J!..lowa"_ _u1remeo.t!._ .cept ~ otherwise provided by state or federal law: , ~~~~ ill Com lete a board or committee a commission' c:::4... Q) Consent to a standard criminal background chec~: 5'. - V ~ ill Be duly rel!istered to vote in Seminole County: I _ y~ ill ----ffi-- . !~:;. ..' ".: . s ,- tJo ------'--------.-- City of Winter Springs Ordinance No. 200 '.49 Page J of 5 . .'" . I I . . . .. , ~ ~'..' 70 i!^ It fC' /J y1 RECEIVED CITY OF WINTER SPRINGS APPUCA TION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITT~Y OF WINTER SPRINGS ICE OF THE CITY CLERK City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. APR 0 5 2007 Please complete the following in the space provided: A. GENERAL 1. tv\~\(\. ~'i-~~? Home Address: C\l\( \uo("\ '-r~e Home Telephone: '--\0'1. 3~~ - J. :S~4 ~ uA\ IJY\M~a- Business Telephone: ~1 8 S l- \ (" :5 q Occupation: ~o \ l1) lJAs:\-~ ~tT. :S.3~ Name: 2. 3. 4. 5. B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y) v/ (N)_ (Y) 'V"'(N)_ 30 ie.AA.-S 2a. Do you live within the City limits of -Winter -Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication. of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)_ eN) \/" 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y)_ eN) V"'" 4b. If yes to 4a. please list each: f " .../ 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. 00 you voluntarily consent to having a M c.l standard background check being performed on you by Initials the City of Winter Springs? (Y).L (N)__ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y)_ (N) ...,/' 6b. If yes to 6a, please provide relalion: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: I hMe.. L\oQ:) \1'\ l0\~ C::;01L\\'\t..<; ~\f\c.e.. ~<2t11 'PmI':> hA-ve.. w~~.q:, \T c'u..ow. I ~<"'e. ~JZ.rt>e \1\ ""i ComMJlh*\ ~ W\1h 40 .5ewe rr. 2. Briefly state any prior experiences in serving on any governmental board or committee: ~o(\ '::;e.~()ol ~V\5.~ """BoA-t~ - 5em,t'loi-e. . ct""\~~~*I:)(iL - Thrr f>k;(J)cv1T Ro~ dv~ 1 uJ/~/t7e:. S C-hf\-W\k ~ CO~ll".e.L(-e.- , 3. In numerical sequence (1 - most interested), please rank which advisory board or committee you wish to serve:. a. -L b. c. d. e. L f. -L g. h. ..L i. Board of Adjustment . Board'of TTustee-s _. .. . Beautification of Winter Springs Boa~d _ Charter Review Committee Gode Enforcement Board Oistricting Commission Oak Forest Wail and Beautification District Advisory Committee Planning and Zoning Board/local Planning Agency Tuscawilla lighting and Beautification District Advisory Committee j. Other: .Please see attachment for description of the advisory board or committee. 2 :.". O. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE ./ African-American Asian-American Hispanic-American Native American Caucasian Not Known GENDER /" Male Female Not Known OISABlllTY Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA"S LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN 0 YOU I YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMJ E, AN INTED, IT IS YOUR SOLE OBUGA TlON AND DUTY TO COMPLY SUC WS. Date: Y ~ (.00, . Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 ;:~ :~.:.ea::=~~'.11:::O~~~::~~~=::~: =~::'t: thC:= or commj~ ~ ill Com lete a board or committee a commission. (:)L m ill Consent to a standard criminal background chec~; ~,-y~ Be dulv rel!'istered to vote in Seminole County; ill. --..---ffi-- . -? . - No City of Winter Springs Ordinance No. 200' .49 Page 3 of 5 '. H~~ ~0.L .'~ :;. .....:.. f REC III::' l!!.~..l'~,.,....,\ =-' .,j;;' ~.. f...;;r ::-_ ..__~,~, ...... APR 2 4 ZOD7 CllY OF WINTER SPRINGS CITY OF VIiINTt:P ~iPf<!;...,~;,; OFFICE OF THE CiTY CLc,''." APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to till out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL Name~ ~ Home Address: ) ~ .. V'~ Home TelePhone:-1Q] ....3~1-1JJ1.... 1. 2. 3. 4. Occupation: Business TelePhone:~01., ~ f;()O 5. B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (y)J.L' (N)_ (Y)~N)_ ~-- 2a. Do you live within the City limits of Winter Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication. of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)_ (N)~ 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y)_ (N) V 4b. If yes to 4a. please list each: '..,/ 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a ~ board or committee. Do you voluntarily consent to having a standard background check being performed on you by Init. s the City of Winter Springs? (Y)~ (N)___ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y)_ (N)~ 6b. If yes to 6a, p1e~se provide relalion: c. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: ~\lvt&\!JW~~~~J~~ a. b.~ Board of Adjustment - Board'of TTuslee-s - - .. - Beautification of Winter Springs Boa~d _ Charter Review Committee Code Enforcement Board Districting Commission Oak Forest Wa'lI and Beautification District Advisory Committee Planning and Zoning Board/Local Planning Agency Tuscawilla lighting and Beautification District Adviso Committee J. ~ Other: ~ .Please see attachment for description of the advisory c. ----l..- d. e. f. g. h. I. 9Wf 2 D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race. gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian-American V Female H ispa nic-American Not Known Native American ~ Caucasian DISABlllTY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY.Of WINTER SPRINGS. UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAt INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES]. WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBUGA TION AND DUTY TO COMPLY WITH SUCH LAWS. Signature: Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 ~ ~i4c\1t" ihal/ m~ II1Y DCtIllIlli'dilg wilhln:::,:~: :J:~==: said-board Of comnuttee. and alleast si~ (6) ;;;9______'-_ 0_____ Idpofnted to the board or committee. Requirements ofboard and ~mmiltee .m~bers. Any ~~n ;~m:~';:ected ora~po~~ted to serve on a board or commIttee of the CIty shall ~d~__ e _0-'0_'1- _ ulremen~~ __pi as otherwise provided by stale or federal law: ill Complete a board or commlltee .applica~ion as Dres~ribed by the city commission: <.>~ ~ 01tJ~ '76~ \~~ . " ?:;. ......:.. m ill -5 . - (\.\~ City or Winter Springs Ordinance No. 2001-49 Page 3 of 5 . . .; .,.... ATTACHMENT "E" RECEiVED CITY OF WINTER SPRINGS FEB 1 3 20D6 APPLlCA TION FOR APPOINTMENT TO CITY ADVISORY BOARD OR CO~~U~ OFFICE OF T~TEE~I~~[!~SK City Code requires prospective and existing board members to filt out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. ....-. Please complete the following in the space provided: A. GENERAL 1. Name: Z clUJ n J2. cL /?_V:; /2/}'/l.oFr- 2. Home Addres~; 9lJ C/ t;,,; Z-P L t~ 7K~/ L. . 3. Home Telephone: ~7-t7.s--S3~-.;2- 4. Occupation: 2. T, /2........J (. 5. Business Telephone: B. ELlGI81LlTY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y) / (N)_ (Y) / (N)_ /f~/ 2a. Do you live within the City limits orWinter Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication. of a felony in any jurisdiction? Any plea of nolo contendere (no conte~t) shall be considered a conviction for purposes of this question. (Y)_ eN} ./ 43. Do you presenUy serve on any other City of Winter Springs advisory board or committee? (Y)~ eN) / / 4b. If yes to 4a, please list each: '../ 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent 10 a standard criminal background check before being appointed to a board or COmmittee. Do you voluntarily consent to having a standard background check being performed on you by the City of Winter Springs? f.# ~,s M_ (N)__ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (y)_ (N) V 6b. If yes to 6a, please provide relalion: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: --::z ~~:,~~:::;:,.7t;;;;/;2;~..~~L4 f;?~~,RIY-U-<- 2. Briefly state any prior experiences in serving on any governmental board or committee: .2 'F llu-+''/ ('),J Q (!-f~.,.,,/' 6w>b/l,r/ - 'S.77Ji:> #? LUHT.e /? ~of/2L 3. In numerical sequence (1 - most interested), please rank which advisory board or committee you wish to serve:- Board of Adjustment , Board'of TTustees - Beautification of Winter Springs Boa(d _ Charter Review Committee Code Enforcement Board Districting Commission Oak Forest Wail and Beautifrcation District Advisory Committee Planning and Zoning Board/Local Planning Agency Tuscawilla Ughting and BeautifICation District Advisory Committee j. Other: .P/ease see attachment for description of the advisory board or committee. a. ~ b. ~ c. -L d. -K... e. -L f. --i- g. -!i- h. J- i. ~ 2 n ':-y. D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board <;tng committee members. Please check the appropriate boxes: RACE ~ African-American Asian-American Hispanic-American Native American Caucasian Not Known GENDER ~ Male Female Not Known DISABILITY ~ Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBUC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW' [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. Signature: 2CkJ~cP R ft;~ _1 --e-L / ~ ;Me; b Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs. Florida 32708-2799 3 me IOIIOWlIlU 1IlC81IIllU: w , "Resident" shall m~ any oerson Iivin~ within the cl~ ~r;u: ~~~ ~~:.:::.::: ~~ said board or committee. and at least six (6) ;;;o~~ ...rl_______ 1___ _ ___ anDOinled to the board or commi,ttee, ReauiremenlS oeboard and committeem~mbcrs. An~p~,:n:,~~in~~~~ora~DO~nted to serve on a board or committee of the CIty shall ~atl~__e _Q...OWlIL- _ulrements~ .cept as otherwise provided by state or federal law; ill Cornalete a board or committee apolication as ores~ribed by the cilY commission: O~ ~'S -z"/O(, ill ill ill --ili- !!) a sences aye OCcurre . City of Winter Springs Ordinance No, 2001.49 Page) of 5 ~',' &~~, , '. ~ RECEIVED FEB 27 2006 CITY OF WINTER SPRINGS ~gFWlNTERSPRINGS _r"", OF THE CITY CLERK APPLlCA TION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. GENERAL . . Name: V 'N{~e)JT -:VA-v;.}) A1llt Home Address: /#/)1- iITrL/3. S~tJd,' W5/ J::L ~::;-P8 Home Telephone: tip T .~ C; 1-/ -if?:; 7-7 . Occupation: D /) Dc ( A--;(4{ r) FeJ.eM Ley fplj e..t!- Business Telephone: LfIJ7-. e-'B lJ... - ~t,b / 1. 2. 3. 4. 5. B. ELIGIBILITY The informa.tion provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y) ~N)_ (Y) t..---""'(N)_ 2a. Do you live within the City limits af-Winter Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty. regardless of adjudication. of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)_ (N) ~ 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y)_ (N) ~ 4b. If yes to 4a. please list each: './ 5. City ordinance requires that aIr persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a,f:\.. & A __ board or committee. Do you voluntarily consent to having a V1t:t""'- standard background check being performed on you by Initi918 the City of Winter Springs? (Y)~ (N) 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (y)_ (N) /" 6b. If yes to 6a, please provide relation: C. INTERESTS/EXPERIENCE 1. BrieOy state your interest in serving on a City advisory board or committee: ~J~~)~a 0pPUAAbun; -H ktil~ 2. BriefJ~ state any prior ~xperiences in, ervi~g n any governm~ al board or ' commIttee: ~ ~ J'l..fMc-r v-~L~ . II!JtJO MIJI,1AJ 3. In numerical sequence (1 - most interested). please rank which advisory board or committee you wish to serve:' a. Board of Adjustment " Board"of TTustee"s - Beautification of Winter Springs Boa~d _ Charter Review Committee Code Enforcement Board b. c. d. e. f. Districting Commission Oak Forest Wail arid Beautification District Advisory Committee g. h. -L Planning and Zoning Board/Local Planning Agency i. Tuscawilla lighting and Beautification District Advisory Committee j. Other:~. D.E , , .Please see attachment for description of the advisory board or committee. 2 O. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race. gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American v--- Male Asia n-American Female H ispa nic-American Not Known ~ Native American Caucasian DISABIUTY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. Signature: Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 me IOIlOWIlll! IlICl1lIlIlIl: \!\Nc~ WIb..t-ttfu !lU ;'R.csidcnt" shall mean any DCrson living within the city limits at .a11 times. while s~ ~~ said board or committee. and at least six (6) months prior to heinli' nomlpated. eL___ anoointed to the board or commi.ttee. Reouirements of board and committee members. Al\.Y person nominated. elccled oraopointed to serve on a board or committee of the city shall satisfy the (ollowinll' reouirements. e~~pt as otherwise provided by stale or federal law: ill Comolete a board or committee .application as prescribed by the city commission: e ~ d(O~ :~ :;. al ill ill -ill- Consent to a standard criminal backirround check: S. _ ~ ~ Be duly relZistered to yote in Seminole Co~ntv: C, _ ~~ Bearesidentasdefinedinthissection:and d ,a.. -~~-S L~i).f'..:>\l=",\~ ..), 'b:') --Hunevcr been conVIcted or louna l!Uiltv. rel!ardless of adiudicali~~:-cl~o~~l; r --- ~- ---- -~ any.iurisdiction anY olea of nolo contendere shall be considered a co~victio~ f~; S.}"lo ourooses of this oar8l!raph. !} City of Winter Springs Ordinance No. 2001.49 Page) of 5 ~f" ~ ,C.; E iV ~", -, . ~...~# AUG 1 5 7:-~1 CITY OF WINTER SPRINGS "ITV OF Wi"r," APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMl1JllJ1e: THe ,.,' ""~L"'f" , (~"--. City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. Please complete the following in the space provided: A. 4. Occupation: GENERAL Name: 'RoberT VrA\rJ belT <1 (~51)'1 ~o~ ~~ Home Telephone: Lf 01 - 3 S'1 - '1'b ~ I ~ .s LA r ~ 0((.1. l LJ 07 - roLJY - 6506 Home Address: 1. 2. 3. 5. Business Telephone: B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: M..dL (N)_ ML(N)_ J 3 ~ I'J 2a. Do you live within the City limits of -winter Springs: 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication. of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)_ (N).-K.. 4a. 00 you presently serve on any other City of Winter Springs advisory board or committee? (Y)_ (N)--X 4b. If yes to 4a, please list each: ; '../ 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a ~ board or committee. Do you voluntarily consent 10 having a '--.L~ ) standard background check being performed on you by Initials the City of Winter Springs? MX (N) 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y)_ (NLK 6b. If yes 10 6a, please provide relalion: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: cr W ~NT -l--D J.\ V ( b~c:...~ --Ju + ~ (0 If) m tvv,~ 2. 3. In numerical sequence (1 - most interested), please rank which advisory board or committee you wish 10 serve:" Beautification of Winter Springs Boa(d _ Charter Review Committee Code Enforcement Board Oistricling Commission Oak Forest Wail and Beautirlcation District Advisory Committee Planning and Zoning BoardlLocal Planning Agency Tuscawilla lighting and Beautification District Advisory Committee j. Other. .Please see attachment for description of the advisory board or committee. a. ~ b. ~. c. ~ d. ~ e. -L f. -:L g. -3-. h. 2- i. .-l Board of Adjustment " Board"of TTUste~s -. 2 D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race. gender and physical disabilities of board and committee members. Please check the appropriate boxes: )L African-American Asian-American Hispanic-American Native American Caucasian GENDER ~ Male Female Not Known RACE Not Known DISABJLITY Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SeCTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBUGA nON AND DUTY TO COMPLY;!JH-SUf.H LAWS. Sjgnatur~~ <b J J:S lOG. Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 .-.. - ot::" .u--......~. . ~.~~~ ....,.. ~ "Resident" shalllnean 'a1tI pcr50n Iivin~ within the cllY limits at .all tim~ ~~ s~~ ~~ said board or conunitlee. and at least SIX (01 months prior to helDe: nomlpa _ el__ __ aopolnled to the board or commi.tlee. Reauirements oeboard and committee members. Any person nominated. elected or aOPOi~ted to serve on a board or committee of the cilY shall satisfv the followinl!: reouirements. ex pt as otherwise provided by stale or federal law: Comolele a board or committee apolication as orescribed by the cilY com(llission:cK.. r:;. ......:.. ill Q1 ill ill --ffr . Consent to a standard criminal baekl!:round 9hcck: S;, - W Be dulv rel!:istered to vote in Seminole County: I, - W Be a resident as defined in this seclion' and 02"1.. / d-lo . - ~.;z...-!, -Has-ne"\'cr been convlclC!1 or found l!:uiltv ree:ardless of adiudic;;(j;;~-~yj;t-~--_ ~ --~_._~--:.-:-- anv'iurisdiction any olea of nolo contendere shall be considered a conviction for J ::" . oumoses of this pBrae:raph. City of Winter Springs Ordinance No. 2001.49 Page J of 5 .....-. CITY OF WINTER SPRINGS APPUCA TION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from seNing on a City Board or Committee if that person has been convicted of a felony. V. Ill'!! r~"'w. RECEI ~~;'$ Please complete the following in the space provided: NOV 2 0 2008 A. 1. GENERAL... . Name J c//J~ ;;;;#IN( l>(:! itttifl j)/I!:' J;!rrc~l;'~~i'~';!I'~K Home Address: 50 8 5'111.)])~6'tvDOD "L J:I . tt//N7iR '$f/2lI/IfPS Home Telephone: 407 - 6:t 7 8:2-:17 Occupation: 5 AL$5 U,qS-UL 7HtcI~ (. Business Telephone: 7' tJ7- a ~ 7 ~.:2 tJ. 7 2. 3. 4. 5. B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: (Y) t-V(N)_ . (Y)~(N)~ :J. '/z vellD5 / 2a. Do you live within the City limits of -winter Springs: , 2b. If yes to 2a, how long have you been a resident? 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)_ (N) t-/ 4a. Do you presently serve on any other City of Winter Springs advisory board or committee? (Y)_ (N) t/ 4b. If yes to 4a, please list each: -./ - 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. 00 you voluntarily consent to having a J F V standard background check being performed on you by Initials the City of Winter Springs? (Y)~ (N)___ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (y)_ (N)~ 6b. If yes to 6a, please provide relation: c. INTERESTS/EXPERIENce 1. Briefly state your interest in serving on a City advisory board or committee: - ~ / :1R~~ (/15 71:-= e 1;Y tt/h'S.ee- . / ~~ ~t'F wc-/Z_ /j'7/ ;t= /1 M. , (,.\"./ - . / 2. Briefly state any prior e eriences in serving on any governmental board or committee: c: -A. e L iB1 ;fA S I5L/ j ,At, -I .... { " 3. In numerical sequence (1 - most interested), please rank which advisory board or committee you wish to serve:. Districting Commission Oak Forest Wail and Beautification District Advisory Committee Planning and Zoning Board/Local Planning Agency Tuscawilla lighting and Beautification District Advisory Committee J. Other: .Please see attachment for description of the advisory board or committee. a. "3 - b. L. c. -i- d. , - e. -5- f. 7 - g. L h. -I--- i. - Board of Adjustment. - - Board'of TTUslee-s -...- Beautification of Winter Springs Boa(d _ Charter Review Committee Code Enforcement Board . .... -....... -. -. - .... -. .... .. ~.... 2 D. STATe REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE v African-American Asia n-American Hispa nic-American Native American Caucasian Not Known GENDER V Male Female Not Known DISABlllTY Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WINTER SPRINGS, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODe OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA ST A TUTESl, WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBUGA TION AND DUTY TO COMPLY WITH SUCH LAWS. Signature: Date: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 3 --,.- -....t;.. ~ T~0J v~~ I ~ "Resident" shall mean any person living within the city limits ~ i~1 ~~~ =. S;Ve:~ ~~ said board or committee. and at least six (6) months pri;; ~ _L~ 0 _i_ _ _ __ _._ aD.J)Ointid to the board or committee. Reouirements ofboacd and committee .members. AIlyperson nomi~ted. elected or:;:pointed to serve on a board or committee of the city shall satisfY the follo~n2 ~~irements except as otherwise provided bv stale or federal law: ill Complete a board or committee .applica~ion as Dres~ribed by the city commission: u.L .r: :;. ..' '.:'. (2) ill ro -----ffi---- - - Consent to a standard criminal background check: ~. -Y ~ Be dulv rel!"istered to vote in Seminole County: I. - ~ Be a resident as defined in this section: and _~ . ,- ~b. - ~ ~ 1 . . . -. Itemate members. a ointed to each Cily or Winter Springs Ordinance No. 2001-49 Page 3 of 5 . .. ,; ,r:" RECEIVED CITY OF WINTER SPRINGS APPUCA TlON FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE CITY OF WINTER SPRING; OFFICE OF THE CITY CLE ~ City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony. DEe 1 1 2006 Please complete the following in the space provided: A. GENERAL 1. ,Name:]) 'tvi 01 Pr,+cheit- 2. Home Address: I 33 Kr i 5+~ An Y) CO"'H'+ Lv",,! -t~ <;' Sf'} ~5 I F( 3d- 706 3. Home Telephone: 4-07 - 3). 7 - If { If 1 4. Occupation: ])i5+r ihl4fi c''("\ 5. Business Telephone: '1-07-66' -II 'f-o B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Seminole County: . 2a. Do you live within the City limits of Winter Springs: (Y)~ (N)_ (Y)L (N)_ 2b. If yes to 2a, how long have you been a resident? 8' yrq (..s 3. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (y)_ (N) vi' 4a, Do you presently serve on any other City of Winter Springs advisory board or committee? (Y)_ (N)~ 4b. If yes to 4a, please list each: 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a ])vp standard background check being performed on you by initials the City of Winter Springs? (yL~_ (N)_ 6a. Are you related to a City of Winter Springs Commission member by blood, adoption or marriage? (Y)_ (N)L 6b. If yes to 6a, please provide relation: C. INTERESTS/EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: tvG'r\e. 2. Briefly state any prior experiences In serving on any governmental board or committee: f'Jo he. 3. In numerical sequence (1 - most interested). please rank which advisory board or committee you wish to serve:" a. , Board of Adjustment b. T Board of Trustees ,........ c. ) Beautification of Winter Springs Board d. 7 Charter Review Committee e. 3 Code Enforcement Board f. :2.. Districting Commission g. h. Y. Oak Forest Wall and Beautification District Advisory Committee Planning and Zoning Board/Local Planning Agency I. Tuscawilla Lighting and Beautification District Advisory Committee J. Other: fqsJ f?",r~1 ~re'1 ~ ':,ri:rTY O...vV"lp.r.> C~""f\"\-tf{( .. I 'Please see attachment for descrrption of the advisory board or committee. I 2 \. D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes. requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE / African-American Asian-American Hispanic-American Native American Caucasian GENDER / Male Female Not Known DISABILITY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF WrNTER SPRINGS, UNDER PENALTIES OF PERJURY. THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF WINTER SPRINGS HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326. FLORIDA STATUTES] AND THE FLORIDA "SUNSHrNELAW" [SECTION 286.011, FLOR/DASTATUTES]. WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPL YWITH SUCH LAWS. Signature: ISQAw! &# l'J-I'8/looC Dale: Please return to: City of Winter Springs The Office of the City Clerk 1126 East State Road 434 Winter Springs, Florida 32708-2799 J 3 ~ Jl:~' shoJI m~ ODV~~r,~~:;.~.:' =1~~==~: ~~ard or comnuttee. and at ~t _ " __ _'L ______!__..:..._____ iWofoted to the board or comml_ ~"::~nls ofboanlJOd ,?mmineemembcrs, ~Y~n::ml:,~-=or:"'~Dred : ~~a board orcommlUeeo(dte~tvBha" adL_c _CLIo n__Le[l~ cept :~: :~d:.: :0' kd~II.w. commission' i~L ~ ~iJ P~I~tr .'.-" ....'.:.. m ill ',~~q ill -n---ffi-- - '\, I ./ S ,-No Cily of Winter Springs Ordinance No. 20() 1-49 Page J of 5 '.