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�rr; rIi <br /> CITY OF CENTERVILLE <br /> APPLICATION FOR APPOINTMENT <br /> P) I 1 <br /> Committee or Commission applying for: 1 h iA, R0 <br /> NAME: CIAV'lle S � hOt/'pL <br /> STREET ADDRESS: / 7 3 vi C <br /> CITY: C vv i I I It ,MN ZIP CODE: U <br /> HOME TELEPHONE: �r �`�� ' 7�4ORK TELEPHONE: Y / 6 <br /> FAX: A" EMAIL ADDRESS: r t/,D iM►� ISD rnR f rC or+ti <br /> Number of years a Centerville Resident?: <br /> Are you presently serving on a Centerville Committee or Commission?: 0' K " pec r 5 <br /> Which One?: Po, r K �L c Term?: <br /> Have you served on a Centerville Committee or Commission in the past?: <br /> Which One?: Term?: <br /> Which One?: Term?: <br /> What do you have to offer the Ci of Centerville as a Committee or Commission <br /> member?: jk ve A-er-e 15, M Sc I-F' L..c ' k� <br /> 'ke- 4 h�ar o �n a ;Kts e ' <br /> Experience or Education that would enhance your effectiveness as a Committee or <br /> Commission member?: <br /> -ke-al %4) to'w Cje a VLA t4 e-4? <br /> 0 rv- e- rrio-� l o-f 46 I- Iwle .5 ,9 k'L " <br /> �r i►'n t -�U f� S �G`Y"CII'L lJ n- h�a�t r' <br /> Signature: Date: <br /> Return to: City Administrator <br /> City of Centerville <br /> 1880 Main Street <br /> Centerville, MN 55038 <br /> 2 <br />