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2. First Name*
3. Last Name*
5. Home Address*
7. Mailing Address - if different *
9. Email Address*
10. Phone Number*
12. Business Name *
13. Business Phone
14. Occupation
16. Business Address
18. Brief Resume of Education and Experience
20. Are you a registered voter in the U.S. and in Belleview?

    1. Yes
    2. No
21. Do you currently hold a public office?

    1. Yes
    2. No
22. Are you currently serving on any Board or Committee?

    1. Yes
    2. No
23. Are you current in your City taxes?

    1. Yes
    2. No
25. PLEASE CHECK THE BOARD(S) YOU ARE INTERESTED IN SERVING ON
    -- Select One --Police Pension Board of Trustees Planning & Zoning Board Other Ad Hoc Committees appointed by the Commission
27. Please list you qualifications to serve the above Board(s)
31. I hereby confirm that I have read and understand this application. That all information furnished by me is true and accurate. That I am in compliance with City Codes, and that to the best of my knowledge, I meet the criteria for serving on the Board for which I am applying.

    1. Yes
    2. No
33. Note

    A) Application effective for ONE Year from the date of completion 

    B) If you have questions regarding this application, please contact the City Clerk, 352-233-2109 or lmerritt@belleviewfl.org 

    C) Financial Disclosure form is required to be completed if appointed to a Board. 

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field