AgendaItem2D-BMRC-7-21-05 Raube, Ed v i 0/04
CITY OF ATLANTIC BEACH
BOARD/COMMITTEE MEMBER /14��S�HEET
NAME OF BOARD/COMMITTEEL. wifrlkir%r \!-`i- ti ,1.)0,;,',.,..p ^ C, " E-v...+ 4,'m 4'1
NAME OF APPLI ANT/MEMBER b (A,..6.--..
ADDRESS )J1 ue...: -II 4 q'.�t fK4'''-s �.s.4.- i ,?M>•-n P0—,n t 1 3z i. 3 t
DAYTIME PHONE q64 814 4113 EVENING PHONE too -L•41/4,, 1 '1-7ri
E-MAIL ADDRESS L�1Re1•-,11-. O \a u 04. "cl"` FAX aY
Please provide a beef explanation of your interest or any special qualifications you have in this field and your reasons for
wishing to be appointed to this board:committee
L-. l_. :-- ,- -i;, 7t,v= rl CUD wtiwi•l\4,i'1
Please return completed form to
Maureen King. City Clerk, BOO Seminole Road.Atlantic Beach.FL 32233