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� L'1�'�t?1'�Jlt�• <br /> CITY OF CENTERVILLE <br /> APPLICATION FOR APPOINTMENT <br /> t � <br /> Committee or Commission applying for: h n ( h ' <br /> � � i <br /> NAME: t ✓�l�t S O l , lee- <br /> STREET � h Oti/'UL <br /> ADDRESS: - 3 /�eGtd p w �` <br /> CITY: C �'` �� f V , l l L , MN ZIP CODE: -5: , y 3 ? <br /> HOME TELEPHONE: �r ���'� 4 AVORK TELEPHONE: <br /> FAX: EMAIL ADDRESS: k �' ' <br /> o rna <br /> Number of years a Centerville Resident?: / 5- <br /> Are you presently serving on a Centerville Committee or Commission?: F"k 9i- pe ; Vt 5 <br /> Which One?: r GZ r K 4 Term?: j <br /> Have you served on a Centerville Committee or Commission in the past?: bo J� i <br /> Which One?: Term?: <br /> Which One?: Term?: <br /> What do you have to offer the Cqv of Centerville as a Committee or Comrpission <br /> member?: re i vc -( r< <br /> �� near o C) S yet <br /> �n errK S `� <br /> I iA vw\a4+C'rj oF O10 V'4" kAo 6"/ 1-ec`✓"A <br /> Experience or Education that would enhance your effectiveness as a Committee or <br /> Commission member?: <br /> ,7�r- Cr-r 0 <br /> +1 i vn t tU r,e S ec-,r I. 8 rL ),jA ot-fft r , <br /> Signature: OK141, Date: J 0, <br /> Return to: City Administrator <br /> City of Centerville <br /> 1880 Main Street <br /> Centerville, MN 55038 <br />