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<br />CITY Of CENTERVLLE <br />APPLICATION FOR APPOINTMENT <br />CornmIlIoecr ~ ~fOr. ~ &.. Za.;,~ ( ()Ift..;~,;" <br />NAME: L- i c \W e.i'l rei <br />STREET ADDRESS: -LG g s WJJ C;.. r J e. <br />CITY: Cet\kJe <br />TELEPHOHE Horne J; - . - <br /> <br />~ <br /> <br />UN ZIP: S'503g <br />Work~ <br /> <br />2 <br />I <br />Number d yearI a CenIIMII8 Rllidel1t -' I ~ Fax <br /> <br />Are )QI pnMIBnIIy .-ving on 8 City d Centsrville Co.I.milt88 or CommiIIIIion? ~ <br /> <br /> <br />Which One? Term <br />Have you .",.. an 8 City d Cenl8rvi11e Comrnitl8e or CcmniI8ion in the pest? ~ <br /> <br />WhiCh One? <br />Which One? <br /> <br />Term <br /> <br />Term <br /> <br />WhIt do you have to an-. to The Cly (I eeranlle cam..... Of~ <br /> <br /> <br />. J\s~Oc;J (. <br />role c&t ~~ <br />DATE~ <br /> <br />SIGNATURE ~ 1llu~ <br /> <br />ReIum to: City rI c.mnille, 1880 Main Street. CentmviI8. UN 56038 <br /> <br />1/ <br />