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<br />a ~~ <br />~ <br /> <br />CIlY OF CENTERVIlLE <br />APPUCAllON FOR APPOINTMENT <br />Committee or Cormlission applying for: ~(\\~~ q, ~\\~ ~ <br />NN4E: ~(\ L F~r~~k~e..\' <br />STREET ADDRESS: l ~ 30 ?e.\ -t-:, e..\' C, fc.. \e- <br />CrN: U,.-l\ kr vi \ 'e.- MN ZIP: 5 50 3~ <br />TELEPHONE Home CoS"l 7~'-\ Co\()~ Work (05\ 71>4. ColO'O- <br />Number of yENn a CenterviUe Resident I, z;- Vtp..fS Fax lt6' 'd.O'"1- 4cr'37 <br />Ate you pr&sentIy serving on a City d Centerville Comnittee or Commission? \JO <br /> <br />---'" <br /> <br />Term <br /> <br />Which One? <br /> <br />Have you served on a City of Centervllle Committee or Comrni&sion in the past? W <br /> <br />~ <br /> <br />Which One? <br /> <br />Term <br /> <br />Which One? <br /> <br />Term <br /> <br />What do you have to offer to TIle City d CenterviIIe eon.,.ittee or Commission? <br />r Co-{\ 'ot\~ ~ ~s" ~~~v<.- -tv ~ P4:- Z. <br />CD~~\kL..... A<vJ. ~ca.vf.L J:- WO('l ~t:V\ h,~1 <br />. <br /> <br />L ()..~ ().J.)()-\ \,,\AG- ~~~~ -\--h- do.-{ (AS <br />-(")~~ . <br /> <br />EXPERIENCE OR EOUCATION THAT WOUlD ENHANCE YOUR EFFECTIVENESS <br />AS A COMMITlEE OR COMMISSION MEMBER <br />K13A -- F;('.o.4'(t- J U~"~ft+y O-f!- Sf-: Ttu~S(~S) <br />O~~ ," Ho(\(<.-ti~, l)W- ~(roJ1L l.1~q) <br /> <br />SIGMTURE ~ rJelJJl <br /> <br />I I <br />I <br />I <br /> <br />- <br /> <br />DATE \\ { r~1 dCOl.o <br /> <br />Return to: City d Centerville. 1880 Main Street, Centerville, MN. 55038 <br /> <br />13 <br />