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Cna.&Z <br /> CITY OF CENT'S MLLE <br /> M SAPPLICATION FOR APPOINTMENT <br /> Committee or Commission applying for: ?our�S F5 ke-C" <br /> .................. <br /> NANIE, <br /> STREET ADDRE SS: <br /> CITY; ..L , >.., M. N ZIPCODE,- 555031? <br /> HOME TELEPHONE: �- B�-9 0�6 WORK TELEPHONE: <br /> ............. <br /> FAX: �............... .......... EMAIL ADDRESS: <br /> Number of years a Centerville Resident?: <br /> Are you presently serving on a Centerville Committee or Commission?: --N-10------------- <br /> Which One?: Term?: <br /> Have you served on a Centerville Committee or Commission in the past?: <br /> Which One?: Term?: <br /> Eptich One?: -------------------------------- Temi?: <br /> What do vou have to offer the City of Centerville as a Committee or Commission <br /> member?: <br /> ......... ............ <br /> .......... ---------------- --------------------------------------------------- <br /> Experience or Education that would enhance your effectiveness as a Committee or <br /> Commission member?: <br /> #� <br /> -------------------------- ...................... -------"I'll"....................................................... <br /> ............... -----------1----------------111111-........ ..............................---............................ <br /> Signature: Date: 1-f /r,11 <br /> ------------------------------------------- nn <br /> - <br /> Return to: City Administrator <br /> City of Centerville <br /> 1880 Main Street <br /> Centerville,DAN 55038 <br />