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4' CITY OF CENTERVILLE <br /> APPLICATION FOR APPOINTMENT <br /> Committee or Commission applying for P rks and( (8wea flag COMP1 i Ise <br /> NAME: C' o ; - 5 Kef3/h C,er <br /> STREET ADDRESS: 1? 3 / Ce alter- f* <br /> • <br /> cmr: C enfervi Ne MN ZIP: S: <br /> TELEPHONE Home (,Si - 175 1 -2_236 Work Lr/- Yez -7S"Z8 <br /> Number of years a Centerville Resident 7 Fax o- 1 <br /> Are you presently serving on a City of Centerville Committee or Commission? /v d <br /> Which One? Term <br /> Have you served on a City of Centerville Committee or Commission in the past? /JO <br /> Which One? Term <br /> Which One? Term <br /> What do you have to o to The City of Centerville Committee or Commission? <br /> '1 <br /> 1 a(/e Letr A Li ( ". . Yyears �I An y(.CKT k real., criha for <br /> 7 <br /> l.yt.frrJ ft-4_ i`"t Th Se✓ve C orhnlun,j 4,,A tt, <br /> Lt Oh area 2 €e I j c.o' W 440-- <br /> EXPERIENCE OR EDUCATION THAT WOULD ENHANCE YOUR EFFECTIVENESS <br /> AS A COMMITTEE OR COMMISSION MEMBER <br /> y ivor 4r /Tto �, Cpun#y /arks 4,- t&joaai t )y/PAri 4nd <br /> ri <br /> � or !a Thar P_ /f <br /> A of A1(L( (A YPp4✓l tt9r 0stea -f cif <br /> a vic WKrf.e Ha notc r, <br /> SIGNATURE ✓ DATE 7 / <br /> Retum to: City of Centerville, 1880 Main Street, Centerville, MN 55038 <br /> 1 <br />