RECEIVED
NOV 1 5 2022
City of Fortuna
City of Fortuna City Clerk
APPLICATION FOR APPOINTMENT TO
CITY BOARD/COMMISSION
Name of Board or Commission:
DERI Aufast
Applicant Name:
FORTUNI
Home Address:
Mailing Address (if different):_
Home Phone:_ Business/Cell Phone:
Emaii Address:
Education:
Length of Time in the Fortuna Area: 758 YeArS
Present Employer: selF
Job Title! Broken
Organizations in which you are currently involved: dore Reason for wanting to serve on this Board/Commission Ae01p= el Sone be avoied wed thie att,
Expertise you bring to his board/commission. Fmne es BeforE. mama Tomi Trent, Tobi Sooger
1415-903
Signature Date
This application will be kept on file for six months.
Board/Commission Application
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