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a -vi <br /> ( entei Ae <br /> CITY OF CENTERVILLE <br /> 77� APPLICATION FOR APPOINTMENT <br /> Committee or Commission applying for, <br /> AME: <br /> STREET ADDRESS: <br /> MN Z111 CODE: <br /> HOME TELEPHONE: = TELEPHONE: <br /> FAX: EMAIL ADDRESS: <br /> Number of years a Centerville Resident?: Number ber f years Centerville Business <br /> Owner?, <br /> Are you presently serving on a Centerville Committee or Commission?: � <br /> Which One?: Term?: <br /> Have you served on a Centerville Committee or Commission in the t?: <br /> Which.One?. Term?: <br /> Which Due?: Term?: <br /> "hat do you have to offer the City of Centerville a Committee or Commission <br /> member?: <br /> ,x <br /> : <br /> ,,4w <br /> Experience or Education that would enhance year effectivenessCommittee or <br /> Commission member? <br /> : <br /> w 4� <br /> Signature: lite �A <br /> City Administrator <br /> Return to: City of Centerville <br /> 1880 Main Street <br /> Centerville, MN 55038 <br />