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Name: lo-indi `Dlkon <br />INDIAN RIVER COUNTY APPLICATION <br />FOR COMMITTEE APPOINTMENT <br />Date: <br />JC�ind !xon., '49 <br />�V" m <br />Full Name: E ail Address: <br />Street Address (No P.O. Boxes): <br />IL <br />-.9 <br />!7 -1-1. , 6752 <br />Home Phone: Work Phone: �,W Cell Phone: W <br />How long have you been a resident of Indian River County? k ;Years <br />Are you a full or part time resident? Check one: Full TimeW]Part TimeEl <br />Please list current employer or business. If retired, please list any business experience that may be <br />applicable to the committee. <br />rt r <br />Gmdp, 1661; n* 6 so <br />Please list any licenses you presently hold: <br />Please list any organization of which you are currently a member: <br />,,Eduh IRCB <br />"."k, Board <br />cati6Foundatioh.of:'o,-gtd-,M6Mbet;!Vdt <br />; VO <br />"66jdt j.F4.ohda' uaIi-tv*;Council: <br />it, Board"' rh <br />Please list any other committees or boards you currently sit on: <br />River Co"Unt. V 8' -�"Vzf f-bbt R" TiE�'I" <br />.yj,voro 'Wffi <br />Continued on next page <br />P77 <br />