Clear Form Mileelama
BOARD OR COMMISSION APPLICATION FORM
DATE: MAY 11, 2026
Check one: New Appointment
Re-Appointment
COmmISSION ON AGING
NAME OF BOARD OR COMMISSION:
NAME: MYRTLE 4 BRAXTON
HOME ADDRESS:
ZIP CODE: 94804 HOME PHONE WORK PHONE
RETIRED
OCCUPATION: EMAIL ADDRE
HOW LONG HAVE YOU BEEN A RESIDENT OF THE CITY OF RICHMOND: _ 53 TYRS.
PLACE OF EMPLOYMENT:_ F
REASONS FOR INTEREST IN APPOINTMENT:
EXTOY WORKING WITH + FOR SENIORS
0 Q
MAY 1 3 2026
chr
FRATERNAL AND/OR CIVIC ORGANIZATIONS:
LAUREL PARK NEIGHBOR HeOD COUNCIL, NAAE
LEAGUE OF WOMEN VOTERS WCCY
EDUCATION:
/ YR. COLLEGE ,/ YR BUSINESS COLLEGE
REFERENCES (Minimum 5-List Name, Address, Phone Number, and Email Address) 1 DIANE COTRICHT
2Lorene Ransbettom
3. Madelyn woods
4. JANet JOhNEr
5._ JACQUETTA ALEXANDER
In the hest of my knowledge the information provided is true and correct:
5/11/26
Date
Or Email to: [email protected]
Print and Sign
Richmond, CA 94804
For Office Use Only: New Appointment: Reappointment: • 1st • 2nd • 3rd