_LaReferred by: _--,-'#'.:.c::..:;q-,-vo",--<~ ___ _
Mayor or Commissioner.
CITY OF SOUTH MIAMI BOARD/COMMITTEE APPLICATioN
6130 SunSet Drive
South Mitun~ FL 33143
PhOMNo.305-663-6340
FaxNo.' 305-663-6348
1".", I am interested in ,ening on the following board(s)/commitlee(s):
". :'-~'.'"
2.
3.
dtJ<:>/T Cd_NI:r/LE
Fint choice
Third choice
Name: /<:,yZ;,//:. rAxo~
(please print)
Set:ond \:hoice
Fourlh choice
HomeAddress: 6'f''><; .rW':C4<.£ .Ii &b'&#Y/-;? 3VY~ :>
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4. Business Address: ;Z /;.1 A,ve .. · ...4 .-:€",., 4,/.",,,,, _ r". .. ?l{<J , C",.."fL 6Jd<'b~ ~< )J)j If
5.
6.
Home Phone No. It:JC-'6.r-/f'70 C...... 3 or -1I'?r _ .ratv
E-mail Address: Kyl!." ,DO,a;.) ~
Business Phone No. jar-37/-9r7J
Fax No. ' _______ _
rAV(?N H..u«. caM
7. Education/Degree Earned: --,.z1.6.~L.2"",-. -,--_=~_.,-___________ _
Pertinent Experience: 7'P ;,;;;:/ ........ t";,. oir L(i.<z} ,
flddExpe~: ____ ~ __ ~ ____________ ~_
8.
9. Attached Resume: 0 (Option:il)
10. Are yon a registered voter?
11. Are yon a resident olthe City?
12. Do you have a business in the City?
Signature ~--e d~
Applicant
Revised 1/14
Yes D'-No
Yes~ No
Yes __ No~
Date L.~7~/
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