Office of the City Clerk, P.O. Box 12910, Pensacola, FL 32521, 850- 435-1606

This application will be utilized in considering you for appointment to a City Council board, authoritiy or commission. Pursuant to Florida Statutes, Chapter 119, all informatioin provided on or with this form becomes a public record and is subject to disclosure, unless otherwise exempted by law.

• Complete each blank on the application

• Completed applications will be kept on file for a period of one (1) year from the date received in the Office of the City Clerk

• It is necessary to contact a member of Council to obtain a nomination in order to be placed on the ballot for consideration. Please go to www.cityofpensacola.com for Council Member contact information. If you have any questions, contact the City Clerk’s Office at the number listed above.

• Please type or print legibly