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<br />~[ CITY OF CENTERVILLE <br />\:". . . . :-! APPLICATION FOR APPOINTMENT <br />Committee or Commission applying for. l' ~ ","nil t. Zn';I~ <br />NAME: J:r i c \tJ e "I) roi <br />STREET ADDRESS: \ G 8 5 I&.kt1fAhJ C;r-c.Je. <br />CITY: Cenldle <br />TELEPHONE Home 5 - 2 - <br /> <br />c ., <br />ni"l\mIS~I()(j <br /> <br />MN ZIP: 5S038 <br />Work ~b 3-l)\4..:JjG 5~ <br /> <br />Number ofyear8 a Centerville Resident Fax <br />Are you presently serving on a City of CenterviUe Committee or Commission? ~ <br />Which One? Term <br />Have you served on 8 City of Centerville Committee or Commission in the past? ~ <br /> <br /> <br />Which One? <br /> <br />Term <br /> <br />Which One? <br /> <br />Tenn <br /> <br /> <br />'t '.. ,'-t"\;, ~ 'J" <br /> <br />;~ 0.. fea~-bo.~~ ~""'t ~iht c.o,Wti'll;>~I~ Md A. d.c.;si"eneu..N~<<''' If is re-q"vi... ;.i ...Io"'l~; ~ ?""'''<<' Je.~h.1t1 milk. <br />EXPERIENCE OR "EDuCATION :r WOULD ENHANCE YOUR EFFEv TIVENESS ~ ,~,,-k bet ;~ ~ be. <br />AS A COMMITTEE OR COMMISSION MEMBER I 1\ <br /> <br /> <br />2 05 <br />J S: Uhivers l+~ iQri da. (Fr.on~rn;c' ~ 2000 <br />..work ('1<ye-;fAlCL lL, ... Ju,;ve<s ~.lfL1r"r""l.t~kArr &. B~~.c;JJ.%OcIJG . <br />~ ~ Ii. r ....---J (cu...4 rei. ..t 14..JI....,,~ <br />SIGNATURE ~l!LD1~ DATE ~ <br />Return to: City of Centerville, 1880 Main Street, Centerville, MN 55038 <br />