RECEIVED
CITY CLERKS OFFICE RICHMOND
BOARD OR COMMISSION APPLICATION FORM
DATE UG 22 PM 3:35
Check one: New Appointment
Re-Appointment
NAME OF BOARD OR COMMISSION: Richmond Commission on Aging NAME: Beverly Wallace
HOME ADDRESS: ! Richmond Ca
ZIP CODE: 94803 HOME PHONE: WORK PHONE:
OCCUPATION: Retired EMAIL ADDRESS:
HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: 87 years PLACE OF EMPLOYMENT:
REASONS FOR INTEREST IN APPOINTMENT:
I enjoy working with the seniors and how much they enjoy the events that the commission puts on each year
FRATERNAL AND/OR CIVIC ORGANIZATIONS:
El Sobrante Chamber of Commerce
West County Forum
Richmond Commission on Aging
EDUCATION:
High School, Contra Costa College, San FranciscoState
REFERENCES (Minimum 5 - List Name, Address, Phone Number, and Email Address)
1. Debra Wold San Pablo, Ca
2. Laurie Myers Concord Ca
3. Elsie Smeaker Richmond Ca
4. Simon Ellis San Pablo, Ca
5. Virginia Nunes Pinole Ca
To the best of my knowledge the information provided is true and correct:
Wallace 8-18-22
Signature Date
Deliver or Mail to: City Clerk Or Email to: [email protected] 450 Civic Center Plaza
Richmond, CA 94804
For Office Use Only: New Appointment: Reappointment: 01st D2d 3rd