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<br />(iitervi{{e <br /> <br />'EstaJ3{isfied 1857 <br /> <br />City of Centerville <br />Best Practices Application <br /> <br />Business Address: <br /> <br />W~~( (juf/ s f;'Z'1-4- <br />-7 tJ q S d(iJ7A 11 ~/c S <br />Business Phone: ~S /- 6' ~3 .- /6 / 7 <br /> <br /> <br />All owners and operating managers please sign, date, and provide a home <br />PhO~ ~~~:{Jontact n.~ /~.b/e~.. _/.) -"7 6 S' / - (,53 - n 8" , <br />?y/t(,u!"r, ((/- 7.(/ c- 'JSI-~/(j-()0iC <br />Signature Date Phone <br /> <br /> <br />0- jq -62 <br /> <br />5A Y>1 ~ <br />Phone <br /> <br />Si <br /> <br />Signature <br /> <br />Date <br /> <br />Phone <br /> <br />~ of Ce t rviUe <br /> <br />~/?I <br />Signature <br />Chief of Police <br /> <br /> <br /> <br />~3-?~~Z51J1 <br />Phone <br /> <br />r <br /> <br /> <br />f <br /> <br />{Sign 1 ure <br />City Administrator <br />-- (/) /?; <br />7:"- . .Ii t.- <br />, , " (, , <br />;/ '. I '. I...." <br />'-- ',' ,," <br />__ JL-~1f.-,,-~ /' <br />Signature / I <br />Mayor <br /> <br />74~) <br />Date <br /> <br />2coz <br /> <br />hS7-'f27- 3232- <br />Phone <br /> <br />I i _ j () _ "1./;:( ':~ ) <br />: ,t i _: ._____ ~;' .~_ <br /> <br />-Y-:2 ~j - 3~,:; -_S .J.':; _ <br /> <br />Date <br /> <br />Phone <br /> <br />Licensed establishments that choose not to participate in the Best Practices U21 <br />Program or are found in violation for a third time will follow the regular penalty grid. <br />