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Home My WebLink About05-07-2024 Supporting DocumentsCITY OF OCOEE 1 N. Bluford Avenue ocoe-e Ocoee, Florida 34761 Igo V "0"" 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are public records under Chapter 119, Florida Statutes, and are open to in , act" persons. perso DATE 7s _�M 1'4 �� /� NAME PHONE # OCOEE RESIDENT YES NO 0 (OPTIONAL) ADDRESS _" . .... . Ai CITY — ZIP CODE E-MAID LIt.�^`A� I want to ad r s B about (Please provide Item # and/or topic): Do you have a prepared statement, or other document(s) from which you will address the Board? No Yes if yes, please attach copy of same to this Reservation Form. All proceedings before the Commission shall be governed by the Civility Code — see back The following time limits to speak are in effect: Public Hearings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public — Citizens Comments - 3 minutes per speaker, per meeting. CITY OF OCOEE 1 N. Bluford Avenue Ocoee, Florida 34761 ocoee f"""c 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are public records under Chapter 119, Florida Statutes, and are open to in pec 'on by all persons. DATE NAME PHONE# OCOEE RESIDENT YES NO 7 (OPTIONAL) ADDRESS CITY ZIP CODE E-MAI I want to address the Board about (Please provide Item # and/or topic): Do you have a prepared statement, or other document(s) from which you will address the Board? No Yes if yes, please attach copy of same to this Reservation Form. IIIIIIIIIIIIIIII•IIII IIIIIIIIIIIII IIII III IIIIIgI 11 The following time limits to speak are in effect: Public Hearings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public — Citizens Comments - 3 minutes per speaker, per meeting. CITY OF OCOEE 1 N. Bluford Avenue ocoee Ocoee, Florida 34761 "O"i"'a 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are public records under Chapter 119, Florida Statutes, and are open to inspection by all persons. DATE - NAME OSCO PHONE #—qbl OCOEE RESIDENT YES V NO 0 (OPTIONAL) ADDRESS -CITY ZIP CODE E-MAIL L-al'-ick Lc� I want to add,rRss the Board apput (Please provide Item # and/or topic): Do you have a prepared tatement, or other document(s) from which you will address the Board? No Yes if yes, please attach copy of same to this Reservation Form. The following time limits to speak are in effect: Public Hearings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public - Citizens Comments - 3 minutes per speaker, per meeting. CITY OF OCOEE I N. Bluford Avenue ocoee Ocoee, Florida 34761 "0"". 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are public records under Chapter 119, Florida Statutes, and are open to inspection by all persons. DATE /7 754 NAME q_-1 Lf�-r' PHONE # OCOEE RESIDENT YES Y NO 0 f (OPTIONAL) ADDRESS DLCITY ZIP CODE_3_�f 7/ 6 1 E-MAIL fi, icv I want to address the Board about (Please rovide Item # and/or topic): � -virLa-11 Mj '�ROZJ al fZfLr_' r4lyrl 'cl —b � I I r Do you have a prepared statement, or other document(s) from which you will address the Board? No Yes if yes, please attach copy of same to this Reservation Form. 1-1111T �"W' The following time limits to speak are in effect: Public Hearings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public — Citizens Comments - 3 minutes per speaker, per meeting. CITY OF OCOEE 1 N. Bluford Avenue Ocoee, Florida 34761 ocoee 407-905-3100 SPEAKING RESERVATION FORM lorida Statutes, and are NOTE: All submitted speaking reservation forms are public records under Chapter 119, F open to ins ction b all er ns. DATE PHONE# �Z �`7 T NAME I OCOETERESIDENT YES NO ❑ (OPTIONAL) ADDRESS CITY Zip CODE Item #and/or topic): V�f t 2, Do you ve a prepared statement, or other document(s) from which you will address the Board? No Yes— if yes, please attach copy of same to this Reservation Form. All proceedings before the Commission shall be governed by the Civility Code — see back The following time limits to speak are in effect: PubIiRjj2Arinqs: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public — Citizens Comments - 3 minutes per speaker, per meeting. At", CITY OF OCOEE el 1 N. Bluford Avenue � L,11-11 14UNNIM601 ocoee Ocoee, Florida 34761 I' 011da 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are -public records under Chapter 119, Florida Statutes, and are open to inspection by all persons. DATE j-? — 7 0 Z NAME -D61V [/-',C yPHONE# 32(— OCOEE RESIDENT YES lid NO El (OPTIONAL) ADDRESS //'� /'I /�-\ U & r- S 0/� CITY �U -t--ZIP CODE L E-MAIL f l (v V---\ I want to address the Board about (Please provide Item # and/or topic): Do you have a prepared statement, or other document(s) from which you will address the Board? No Yes if yes, please attach copy of same to this Reservation Form. The following time limits to speak are in effect: Public Hearings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public - Citizens Comments - 3 minutes per speaker, per meeting. CITY OF OCOEE 4 1 aw %d IdF 1 N. Bluford Avenue Ocoee, Florida 34761 ocoee florida 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are public records under Chapter 119, Florida Statutes, and are open to inspection by all persons. DATEca (Y�/ NAME PHONEo OCOEE RESIDENT YES—,-t�- NO 7 (OPTIONAL) ADDRESS CITY ZIP CODE E-MAII I want to address the Board about (Please provide Item # and/or topic): Do you have a prepared statement, or other document(s) from which you will address the Board? No Yes if yes, please attach copy of same to this Reservation Form. Alt V The following time limits to speak are in effec PublicHearings: t: 1-5 EgArings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebutta minutes. Open to Public — Citizens Comments - 3 minutes per speaker, per meeting. CITY OF OCOEE 1 N. Bluford Avenue ocoee Ocoee, Florida 34761 florldo 407-905-3100 SPEAKING RESERVATION FORM NOTE: All submitted speaking reservation forms are public records under Chapter 119, Florida Statutes, and are open to inspection by all persons. DATE NAME PHONE# OCOEE RESIDENT YES NO FD (OPTIONAL) ADDRESS / Z "/'- . - — - CITY —ZIP CODE E-MAIL I want to address the Board about (Please Do you have a prepared statement, or other document(s) from which you will address the Board? No V_ Yes I L if yes, please attach copy of same to this Reservation Form. _f2sl— All proceedings before the Commission shall be governed by the Civility Code — see- back The following time limits to speak are in effect: Public Hearings: petitioner presentation - 15 minutes; citizen comments - 5 minutes per speaker; petitioner rebuttal - 5 minutes. Open to Public — Citizens Comments - 3 minutes per speaker, per meeting. APPLICATION FOR SERVING ON CITY BOARDS Please use this form to apply for appointment to a citizen advisory or quasi-judicial board. Completed applications must be signed and submitted to the Office of the City Clerk, I N. Bluford Ave., Ocoee, FL 34761 or emailed to ccdl(@ocoee.org. Applications are valid for one (1) year from k_J C kO the date of submission. Please direct any questions to the Office of the City Clerk, 407-905-3105. florida All submitted applications are public records under Chapter 119, Florida Statutes, and are open to inspection by all persons. Name (please print) E-mail Address O'l. MLe_rCf�C, y Home Address OCAe e. r--L. 3 Phone 2 City Resident at Least 6 Mori'ths? es [:1 No City District # When possible, equal representation for all districts shall be maintained on all advisory boards, and the City Commission shall consider the ponet Place of Work Business Address M_ US Citizen? Yes F1 No Registered Voter?�K`e�sNo CityEmployee? []YeNo Dept. '�o ;;a quasi Presently Serve on Quasi-judicial Board? Cl Yes o If yes, please describe State law prohibits service on more than on quasi-judicial board orelectedlappointed office. Please indicate the board(s) for which you seek appointment by the City Commission. Financial disclosure and/or background checks are required for certain citizen board members; see footnotes. [] Citizen Advisory Council for Fire Dept.2 R Parks & Recreation Advisory Board' F] Citizen Advisory Council for Police Dept.' ".�;T`lanning & Zoning Commission' Code Enforcement Board' Personnel Board Ej General Employees' Retirement Trust I Fund Board of Trustees' F, Police Officers' and Firefighters' Retirement Trust Fund Board of Trusteesi ELHuman Relations Diversity Board12 f. — I 1 Financial disclosure forms must be submitted after appointment to a quasi-judicial board. 2 Background checks are required before a member may participate in public -contact events. Is this for Reappointment? D e Yes P Have Attended at Least 1 Meetia of Requested Board(s)? E] Yes No I You are strongly encouraged to attend at least one meeting any board for which you seek appointment prior to submitting your application. M List any education, rskill orcivic involvement that would berelevant toserving onaboard. Is a Resume Attached? E]Yeo No A-4 Uc-- Special Knowledge or Skills: t_ We "ISYq q Ce oL -J Community/Civic Organizations & Involvement: Hobbies or Special Interests: F DGK4ENT(Check Relovv: | understand that in accordance with the Florida Sunshine Law, this information will be available for u blic review and I waive any objections to such publication. If appointed, I agree to faithfully and fully perform the duties of the Board, make every endeavor to serve my full term, and will comply with all laws or Ordinances of the City, County, and State of Florida. I understand, if appointed, an updated application must be submitted to seek appointment to another dvisory board. | �| | understand that Financial disclosure forms must be submitted after appointment to a quasi-judicial / board. STATE REPORTING REQUIREMENTS Seotion76O.8U, F.S., requires the City submit a report annually to the Secretary of State disclosing race, | gender, and physical disabilities of board and committee members. Please check the appropriate boxes below: Race Gender Disability QAfrica n`4rnericanFlPhysically Disabled �l/\s|mn-Ammrioon el- [3 Female �� / 0Hiypenio-American � � Native American ' �uoasmn Signature