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4 )1' <br /> CITY OF CENTERVILLE !4 <br /> wall: APPLICATION FOR APPOINTMENT <br /> Committee or Commission applying for: 4c /c 7 / € vr'c n. a c 40n <br /> NAME: $‘c-,Join Li a ettle <br /> STREET ADDRESS: 163 3 MAi vY 2;4 1n1 <br /> // <br /> CITY: �2✓i fe ( MN ZIP: 6 3 TS <br /> TELEPHONE Home ( o l a 0 I - r Work b S1- T i - to 05 <br /> Number of years a Centerville Resident 1 Fax /��/ <br /> Are you presently serving on a City of Centerville Committee or Commission? /(/v <br /> Which One? Term <br /> Have you served on a City of Centerville Committee or Commission in the past? /r'O <br /> Which One? Term <br /> Which One? Term <br /> What do you have to offer to The City of Centerville Committee or Commission? <br /> slew a avismis.sion 7 ,tav 6 art," � Cents'eta- (A4k)/ ( ads . <br /> ?r� <br /> wire Aaae- a el :04J7e docLr� o Cac - 6e) 74es anot cc <br /> a'eSire. S'er sty r e anactai ca r A/ 221M Ca•-be <br /> EXPERIENCE OR EDUCATION THAT WOULD ENHANCE YOUR EFFECTIVENESS <br /> AS A COMMITTEE OR COMMISSION MEMBER y p <br /> ie o e✓n / 1 alder si0 ✓o & s 'fRda ilio l su ) E I n I'T cat/en -" derr 0n / 4 LL �� 044 <br /> - atir /Sea+ % .A a Af / do(e � n m Career' Y r /och , cciu-SS�"/v a ` <br /> ▪ �S C thee+ Gafd Lay7ne7r ca t GirFevre ` o b1 rests ,4a - ads <br /> SIGNATURE DATE 7 <br /> Return to: of Centerville, 1880 Main Street, Centerville, MN 55038 <br /> 3 <br />