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<br />€i... <br />f,;~"t'.~iijtervi[[e <br />?; ~,--= <br /> <br />City of Centerville <br />Best Practices Application <br /> <br />Business Address: <br />5'4 1i6~ ~//il/tJ/? - 7;)9,? }o t} 4(/( ~~ <br />k4/~;;12 vi! t r, /Jj/v" Sf oJ? <br />Business Phone: oS! / Ij JI /61 )j/ <br /> <br />All owners and operating managers please sign, date, and provide a home <br />Pho.~ne r othe eliable contact number. <br /> <br />LJJ11dLtL j <br /> <br />. gnat e <br /> <br /> <br /> <br /> <br />Signature <br /> <br />Date <br /> <br />Phone <br /> <br />Signature <br /> <br />Date <br /> <br />Phone <br /> <br />//'"~ /", <br />~4~' <br />!:Signature <br />City Administrator <br />. /~ ~'"J If; <br />~--r i...fk ..../ <br />I _______. . \,.../'-4/, <br />Signature ,/ / <br />Mayor "~ <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 /> <br /> <br />/ ~A:ft1 ~Z5..t7j <br />Phone <br /> <br />7~. L( 4)C)2- 69-t!2.c;'- .3232- <br />Date Phone <br /> <br />/ /-/1- :1.L:GJ} <br />Date <br /> <br />'! I .., ...,,, 7..-.. <br />I/}<"'; - ).2 " j <br />! .~~ { - - .~~"--- <br /> <br />Phone <br />