2008 Preston CITY OF BOYNTON BEACH 4
ADVISORY BOARD APPOINTMENT APPLICATION
Thank you for your interest in serving on a City advisory board and for taking the time to fill out this form.
Please print or type all answers clearly. If interest is expressed in appointment to more than one board, selections must be
prioritized. If instructions are not followed or the application is not filled out in its entirety, the form will be returned for clarification.
Name ! g K14 1 1=5 to 4/
Address I o 0 c S . (4^ J�f//C
City t7WA/76 State IFL Zip Code j_53y.- 6,
E-mail Address I A/c /(l
Current occupation or, if retired, prior occupation �f, {j fi--(e"5 (r y /cf/ ( Cg
Education I icto `L ss QQ , Ae(' /91,2 I @'t.c(-(-Cts -- 75/(g1
Are you a registered voter? )6es C No
Do you reside within the Boynton Beach City limits? (YYes C' No
Do you own/manage a business within City limits? C'Yes e1 Jo
If"yes", name of business:
Are you currently serving on a City board? jOes C No
Have you served on a City board in the past? ,Yes C No
If so, which board(s) and when? C teeNt C/ ',. 01 5AdZ4 Se. YC6 f y
Have you ever been convicted of a crime? C Yes tlo
If so, when? Where?
Please indicate(by number)to which advisory board(s)you are seeking appointment. You may serve on only one board.
Please do not check more than three boards. Prioritize your choices by number, 1 being the most desired and 3 being the least preferable.
For board requirements,responsibilities and meeting times and dates,see the attached listing.
Arts Commission Firefighters' Pension Trust Fund
Building Board of Adjustment&Appeals Golf Course Advisory Committee
Cemetery Board Library Board
Code Compliance Board Planning & Development Board
Community Redevelopment Agency* Police Officers' Retirement Trust Fund
Community Relations Board Recreation & Parks Board
Education and Youth Advisory Board Senior Advisory Board
Employees' Pension Board Veterans Advisory Commission**
* Resume required
** List Branch of Military Service or Organization on Reverse Side.
Jr-
What
What personal qualifications do you possess (i.e., profession, previous experience, branch of military service or organization) which
you feel would make you a good candidate for this board? Please be specific.
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First Choice: IL L E t.
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Second Choice:
Third Choice:
Feel free to attach an extra sheet or resume. Return the completed form to:
City Clerk's Office, 100 East Boynton Beach Boulevard, City Hall. Mailing address: P.O. Box 310, Boynton Beach, FL 33425-0310
FAX to: (561)742-6090
It will be placed in the City's Talent Bank, a file to which Commissioners may turn for candidates when board openings occur.
I hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false
statements may be cause for removal from a board.
Signature: ��
f7z,eztfr&--- Date:11110 az Q
4
BOARD MEETING DAYITIME RESPONSIBILITIES
To develop a plan and programs to promote and support Art In Public
Places, and to recommend guidelines and funding for implementation.
Arts Commission 4th Tuesday-6:30 PM Members shall
be residents or business owners, preferably artist, art volunteer/activist,
planner, private developer, architect, neighborhood association member,
interested citizen.
To hear appeals of decisions and interpretations of the Building Official and
consider variances of the technical codes. Members shall have knowledge
Building Board of On Call and experience in the technical codes to include an architect, engineer,
Adjustment&Appeals general contractor, electrical contractor, HVAC contractor, plumbing
contractor and any other contractor licensed category. One alternate
member may be member at large from the public.
Establishes rules and regulations for the management of the City's
Cemetery Board 2nd Thursday @ 6:00 PM cemeteries and makes general recommendations to the Commission
concerning their condition and development. At least half of the members
must have cemetery or mortuary experience.
Rules on code violations that are not corrected and attempts to find an
Code Compliance Board 3rd Wednesday-7:00 PM equitable resolution to those problems. Membership is to include an
(&Lien Reductions) 4th Wednesday-3:00 PM architect, a business person, an engineer, a general contractor,
subcontractor, Realtor and/or those with building trade experience or other
related technical experience.
Within the Community Redevelopment Agency boundaries, approve,
update, and implement all development and redevelopment plans; review
and make recommendations on all development master plans, site plans
2nd Tuesday & 3rd and Planned Unit Development; approve the acquisition, demolition,
Community Thursday (if necessary) - removal, or disposal of property as needed to alleviate slum and blight;
Redevelopment Agency 6:30 PM hear and decide administrative appeals, special exceptions and variances
related to land development. Membership should include, but is not limited
to, design professionals licensed in the disciplines of architecture,
landscape architecture, landscape design, planning, real estate and
economics.
Provides a vehicle for citizen input on problems directly affecting the
Community Relations 2nd Wednesday- delivery of services connected with health, welfare, safety and housing,
Board 7:00 PM and provides information programs.Also reviews and recommends
expenditure of funds allocated by the Commission for social services.
Education and Youth To identify the unmet needs of education &youth in Boynton Beach and to
Advisory Board 4th Thursday-7:00 PM make recommendations to the Commission as to how those needs can be
met.
Continued on next page...
a
Continued from prior page.
BOARD MEETING DAYTIME RESPONSIBILITIES
Feb., May,August, Nov. Members are Mayor, City Manager, 2 Commission appointed and 3
Employee Pension Board
Friday(TBD)- 1:30 PM employee elected.
Firefighters' Pension Thursday after the 15th Members are 2 Commission appointed, 2 employee elected and 1 Board
Trust Fund Feb., May,Aug., Nov .- appointed.
4:00 PM
Gives input and advice on general planning, maintenance and operation of
the City of Boynton Beach municipal golf course. The committee does not
Golf Course Advisory 2nd Thursday-3:00 PM
consider funding or financial management of the course. those appointed
Committee Every other month
by the city must be annual permit holders and/or reasonably regular
greens fee players. Membership is from throughout the county.
Advises the City Commission, meets regularly with the Library Director
Library Board 4th Wednesday-4:00 PM and provides support for the city's library system. Must be Boynton Beach
library cardholders.
Responsible for reviewing and making recommendations on all
development master plans, site plans and planned unit developments,
reviewing the zoning ordinance, making recommendations on rezonings
Planning & Development 4th Tuesday 6:30 PM and revisions to the zoning and subdivision ordinances. Also makes
Board recommendations concerning the aesthetic attributes of these projects.
Membership should include, but is not limited to, design professionals
licensed in the disciplines of architecture, landscape architecture,
landscape design and planning.
Police Officers' 2nd Tuesday in Feb., May, 2 Commission appointed, 2 employee elected, 1 appointed by Board.
Retirement August, Nov.
Provides citizen input and makes recommendations relative to the
Recreation & Parks programming and facility development. Board
Recreation & Parks 4th Monday-6:30 PM representation will include all ages, and members should have experience
Board and knowledge in recreation programs, community special events and/or
park and facility design, development and maintenance.
1st Monday-3:00 PM To identify the unmet needs of elderly residents and to make
Senior Advisory Board
Every other month recommendation to the Commission as to how those needs can be met.
To provide the City Commission with advice and recommendations
Veterans Advisory 2nd Wednesday- 10 AM regarding matters pertaining to the affairs of veterans residing within the
Commission Every other month City of Boynton Beach. 1
ENLISTED RECORD ANID REPORT OF SEPARATION
69 1-29 HONORABLE DISCHARGE
I. LAST NAME . FIRST NAME • MIDDLE INITIAL 2. ARMY S[RIAL NO. 3. GRADE 4. ARM OR SERVICE 6. COMPONENT
PRFSTON STUART I 1.2 170 314 S/SGT SC ALIS
6. ORGANIZATION 7. DATE OF SEPA TION 5. LACE OF SEPARATION
8 OCT -11., UNIT B SFP CTR #45 IGMR PA
9. PERYAN A.DRESS FOR MAILING PURPOSES
I 10. DEt OF BIRTH�- II. PLACE OF BIRTH
RD 1 OSWEGO NFW YORK 9 JI 192 OSWFTO NFW YORK
12. ADDRESS FROM WHICH EMPLOYMENT WILL BE SOUGHT 13. COLOR EYES 14. COJR HAIR 15. HEIGHT 16. WEIGHT 17.NO.DEPEND.
SEE 9 HAZEI AROWNL 5I 1o" 155 LBS. 1
1B. RACE 19. MARITAL STATUS 20. U.S. CITIZEN 21. CIVILIAN OCCUPATION AND NO.
WHITE I NEGRO IOTHER(SpeCify;SINGLEI MARRIEDI OTHER (specify) YES -40
( STIinrMT rnl i F'rc )1-n2
MILITARY HISTORY 1
22. DATE OF INDUCTION 23. DATE OF ENLISTMENT 24. DATE OR INTOACTIV[S[aVIC[ 25. PLACE OF ENTRY INTO SERVICE
22OCT 1� 27
SELECTIVE
28.R[GIST[R[D 27.LOCAL O.CAiu„x-226. COUNTY AN 29.MAR 43 2.FORTWARESSWA_
AT TIME N ENTRY ,YOTO K SERVICE
SERVICE ► r[5 I x0
DATA YY FULTON NEW YORK-I_SEF��--
30. MILITARY OCCUPATIONAL SPE ALTY D NO. SI. MILITASTOUALIFICATIONANDDAT[(i.e.,infantry,aviationandmarksmanshipbadges,etc.)
RADAROPERATOR CARBINE M1 EXPERT 14.5
32. BATTLES AND CAMPAIGNS
to 33 & kOwD 45
AIR OFFENSIVE-EUROPE NORMANDY NORTHERN FRANCE RHINELAND ARDENNES
cENVTRAL EI OPE
] ECORATIONS AND CITATIONS GOOD CONDUCT MEDAL AMERICAN THEATER SERVICE
MEDAL EUROPEAN AFRICAN MIDDLE EASTERN SERVICE MEDAL W/6 BRONZE STARS
MFR I TOR I OUS SFRV LCF UNA T PI AQIJF
34. WOUNDS RECEIVED IN ACTION
NnNE
35. • LATEST IMMUNIZATION DATES 36. SERVICE OUTSIDE CONTINENTAL U. S. AND RETURN
SMALLPDX
M 1LFEB145 27FEBTYPFCCIfo 411.12LIANus FEBI11. 11FER B45 j ecify) DATE OF DEPARTURE DESTINATION DATE OF ARRIVAL
TYIVHIIS 22 JAN 11.11. ETO 28 JAN 2414
37. TOTAL LENGTH OF SERVICE 39. HIGHEST GRADE HELD
CONTINENTAL SERVICE FOREIGN SERVICE
YEARS (MONTHS(DAYS (YEARS -(MONTHS JOAYS- •- -- r -. 13- OCT 1+5 USA • 211OCT 115
°. PRIOI�SERVICE 29 1 9 3 S-SGT
NONE FOa r)t ; -. ;..7"- t rIQ'r,l I,;).$../..6.03. 5 t14
40. REASON AND AUTHORITY FOR SEPARATION '! -F ' - +
AR $1.5- 6,5 RRED1-1 DEMOBILIZATION
Al. SERVIC 42. EDUCATION (Years)
3 Crammer I HI91LSchool I College
SIGNAL RADIA-44ECI.1444•CS 1 WEEKS Oa 14� I n
PAY DATA
43. LONGEVITY FOR PAY PURPOSES 44. MUSTERING OUT PAI, 45.[OLDI[a DEPOSIT[I 46.
TRAVELEPAY 47, TOTAL AMOUNT, NAME OF DISBURSING OFFICER
YEARS 'MONTHS (DAYS ---IsOTAL !THIS PAYMENT IS I ?. "{ 0 Z� D-s
3 7 -l4 [�7�[�1 1 .1 .1 MAHFR JR
INSURANCE NOTICE MAJOR FD
IMPORTANT IF PREMIUM( IS NOT PAID WHEN DUE OR WITHIN THIRTY.DXF. TI'-YS Tlrl'IIEAFTF.R, INSURANCE Wii.l.I.APSF.. MAX}; CHECKS OIC MONEY ORDERS PAYABLE
TO THI:TREASURER OF THE U. S. AND FORAt'.ARD TII COLLECTIONS BUDDIVISION, VETERANS ADMINISTRATION, WASHINGTON 25, U. C.
4B. KIND OF INSURANCE 49. HOW PAID 50. EReetive Date o}Allot. Si.DAte o}Naxt PL917:95107. 52.PREMIUM DU[ B]. I ION OF VETERAN TO
.hat.Serv.I U.S.Govt.I None I Allotment I Dlreet to ment Di aeontlns.nu (One month EACH MONTH
x 31 OCT 14 5 3n MQ�L �5 s Sn CvtlnM. ntlnMe Only Discontinue
V.A.
34 :,-.--;1;,.2,k7.,._, ,,N.
_ 55. REMARKS (This space for completion of above items or entry of other items specified in W.D.Directives)
-� 1. 2 LAPEL BUTTON ISSUED
d`3, x31 N.3 y ARS SCORE (2 SEP 11.5) 8o
3 f.µ fit;
56. S r /.' I'..'BEING SEPARA 0 57. PERSONNEL OFF CER (Type name,grade and organization-signature)
( ;.,(. S M ROLAND
-• . . _ _L. , p� `...�a�� 1 STET QMC �/ / /
w0 AGO FORM 53.55 This form supersedes all previous editions of 0
1 November 1944 WD ACO Forms 53 and 55 for enlisted persons
entitled to an Honorable Discharge, which
will not be used after receipt of this revision.