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<br />I WInter 2000 <br /> <br />CenreMIe: ".....,... ~ wIIfe FOCUIIIJf 011'" f'UIIn <br /> <br />"9 <br /> <br />Please Circle the award that you are ~ for: <br /> <br />City of Centerville Citizen of the Year <br /> <br />or <br />City of Centerville Business of the Year <br />Nomination Form 1999 <br /> <br />Name of Nominee: <br /> <br />Phone: <br /> <br />Address: <br />Please check the oiganizations or groups this individual is associated with and write name of committee this <br />persoD is actively involved in. If not listed please write name of organization in the Other column. <br /> <br />~ City ofCenterville Committee: ~ Local Organization: <br />~ Local Organization: ~ School: <br />~ Church: ~ Other: <br />~ Other: ~ Other: <br /> <br />Please list below the task that this individual has accomplished during this past year that have been ofbene- <br />:tit to our city and it's residents: <br /> <br />!'. <br />II <br /> <br />Are t)lere any other fictors you feel may be important to consider regarding this nominee: <br /> <br />Nominated by <br /> <br />Date <br /> <br />Address: <br /> <br />Phone: <br /> <br />. <br />