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crii <br />terVifffe <br />City of Centerville <br />Application for Appointment <br />Council/Committee/Commission/EDA applying far?: l " a 16 <br />Name: 'bt mot <br />Street Address: I c , e ki .i-4.-j <br />City: NiN <br />Work Telephone: <br />Email: -0090���� <br />R Number of years Centerville Business <br />Horne Telephone: <br />Cell Number: <br />Number of years a Centerville resident?: <br />Owner? <br />Zip Code: 5SZ 39 <br />Are you presently serving on a Centerville Committee/CornmissionjEDA? <br />Which one? <br />Term?: <br />Have you served on a Centerville Comm ittee/Cornmission/EDA? � C> <br />Which cane? F-0 t k- e- , t5Z It3Y`' Term . a, S - a66C <br />Which one? <br />Term?: <br />iJ O <br />What do you have to offer the City of Centerville as a Council/Committee) mmisskorfj DA mem r? _ <br />r f � <br />Experience or Education that would enhance your effectiveness as a <br />Council/�ommitt ee/Commission/EDA member?: <br />II �� _ r I t -ram <br />Sign atur . Date: <br />Return to: City Administrator, Mark Statl <br />City of Centerville <br />1880 Main Street SUBMIT <br />Centerville, MN 55038 <br />