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CITY OF SOUTH MIAMI BOARD/COMMITTEE APPLICATION
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6130 Sunsel Drive
South Mia"li, FL 33143
Phone No. 305-663-6340 ~ ~ .tl
Fax No. 305-663-6348 'T! ~ ~ ::n ~""J.
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I am interested in serving 011 the following board(s)/committee(s): Q =, --------_._--
First choict b d . "f-k.......,,--u "'" .;, Third choict . Fourth choIce
Name: \)(>..V\{<2.1 M0Y\±aW\D<.
(please print)
Home Address: b 7'7 () $t>0 :{f, ~ lC
Business Address: ~,,;»"'''''-''''''''''-'-'&.--''= _________________ _
IIomePho~eNo.3D>~ {, Prb>O 'S :SusinessPhoneNo. 'SO'C; $'3{ -IO'l D
\ Fax No.
E-mailAddress: l·!M<>vU",-",o-eb(l::. 0 I/-t'"' , Ylf >r-
EducationlDegree Earned: _. )?,'-"-. C>.=.~-,E_· 0"''';:;:9''\,,';'''1"''''''-___________ _
Pertinent Experience: ____________________ _
Attached Resume: 0 (Optional)
Are you a registered voter?
Are you a resident ofthe City?
.Do you have a business in the City?
Yes~
Yesd
Yes
Date /' r1.-! { I f
No
NO_j
No~
Revised 512010