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CITY OF CENTERVILLE
<br /> APPLICATION FOR APPOINTMZNT
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<br /> O TELEPHONE: -5'1713WORK TEU..'EKIONE. "7 V-- r516)
<br /> EMAIL ADDRESS: ,......... � � � � ��
<br /> Number of years a Centerville Resident?: mm2 0 Number of years Centerville Business
<br /> Owner?:
<br /> Are you presently serving on a Centerville Committee or Commission?:
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<br /> Have you served on a Centerville Committee or Commission in the past?: m
<br /> WhichOne?: . ............................... Term?: .................m..............................................................................M...................................n
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<br /> Which One?: Term?:
<br /> What do you have ........ er tb7 Cit. of Cviit ll� . rnm mtte iii°I Commission
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<br /> Experience or Education that would enhance our, e veness as aYomni or
<br /> Commission member?: Z
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<br /> Signature: .w.. n,....................... _.......:.........:......... �-
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<br /> Return to: City Administrator
<br /> City of Centerville
<br /> 1880 Main Street
<br /> Centerville,MN 55038
<br /> 5
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