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'33 My AI/hi/ se -/3 / ,€ sace <br />Last <br />Name: <br />INDIAN RIVER COUNTY <br />APPLICATION FOR COMMITTEE APPOINTMENT <br />Today's Date: <br />Home Address (No P.O. Boxes): <br />Home Phone: <br />172 - 53 2 -/b <br />First Name <br />& Middle Init: <br />Email Address: <br />L.. <br />P <br />1 CEM <br />DE C i 9 Zli <br />HOARD OF 1J tt s Y <br />COMMIS ION <br />Work Phone: <br />How long have you been a resident of Indian River County? <br />Cell Phone: <br />a& yrs -74 <br />Are you a full or part time resident? Check one: Full Time Part Time <br />Please list current employer or business. If retired, please list any business experience that may be <br />applicable to the committee. <br />4 _ !/GFS/i44c'Sil�e SL-/¢�%7�it/ /r/dl� <br />/LES ardent92. ; <br />Please list any licenses you presently hold: <br />Please list any organization of which you are currently a member: <br />Se2f157,4,ti i vF 7 -711%/4// Pi5?1 ar 4o l rCiDAle; ' y <br />Urtr-v. uJ/3y JP- /Ac, 6,4024> <br />Please list any other committees or boards you currently sit on: <br />°451" $E - /� ' . ,3& y�-6 s #0/16-3 ., Co4lfli1 ei� C/ rrr& <br />6 i2v rt ifk-,l /Lr , .1A044/, ea,t/d wiL VEvEzolliktfii- Cel, t <br />C-/ 1Z, . <br />Continued on next page <br />4 <br />