Stambaugh, Charles CDB 2-5-2003 v AGENDA ITEM#$B
APRIL.14.2003
FEB 052003
CITY OF ATLANTIC BEACH "`
CLERK
BOARD MEMBER INFORMATION SHEET
NAME OF BOARD t—ANn/►v
NAME OF APPLICANT/MEMBER R ( AQA(.L��' Tf +11.'�-+;
ADDRESS 117 U�P &Mk/ L.VI'T
DAYTIME PHONE Z9l- 2-yl 7 EVENING PHONE 1-92 —9�`Or
E-MAIL ADDRESS C;1r4ft •4v/.4&4tfg )• GM/ FAX* Z-11/-
Please
t /Please provide a bnef explanation of your interest in this field and your reasons for wishing to be appointed to this
board.
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Please return completed form tc
Maureen King, City Clerk. 800 Seminole Road. Atlantic Beach. FL 32233