|
<br />~
<br />
<br />CITY OF CENTERVIllE
<br />APPLICATION FOR ~PO'N1MENT
<br />l/'~/
<br />Cch..~or.~ applying for: j-//.?Ni1''';.1 ,i (()i~);'f/j"/
<br />. f
<br />....E: L~""C;';v; v-... L- /11,.):,; {. (,-
<br />
<br />STREET ADDRESS- I C::(,/ <1
<br />o I /, ,
<br />
<br /><' /
<br />(r_t~,'7 ..-
<br />r
<br />
<br />I (
<br />( . ;
<br />
<br />CITY: /~t1-fs::.;^V./ /~
<br />TB..EPHONE Home (:<;/- <()'i- 571-/
<br />
<br />MN
<br />
<br />ZIP: S~() >,-{
<br />
<br />~/-' >Db ,,'),(j() /
<br />
<br />Work
<br />
<br />
<br />Nwnberdyears a Centervitle Resident / J:,Ve~""c Fax
<br />
<br />~ you presently serving on a City of Centerville Committee or Commission?
<br />
<br />rJo
<br />
<br />Which One?
<br />
<br />Term
<br />
<br />H;we you served on a C;ty of Centerville Committee or Commission in the past?
<br />
<br />Whid\ One?
<br />
<br />Term
<br />
<br />Which One?
<br />
<br />Tenn
<br />
<br />\\4hat do you have to offer to The City of Centerville Committee or Commission? z:; Vv ku~
<br />
<br />
<br />OIA V.ctJO; & v.> CO~ .....;-i4'i!..~s ~t.c:.j vr!~ V1 G",,.- ';:;;'-1(.. ~_ < ,':.ft'!._~ {:,.....
<br />,
<br />
<br />n... o-..J' ~<~ lifIL~' <. c:<. _.1. k",.::- r/'~'f.;'__ +~ Qn?I?,.,..-1 bK r;.J: / >4_
<br />, r
<br />--.L r' ~ I ", '...L' ~ (e..<(/h ,;jj,/'.
<br />W~-f"-G-"-'L ...... .or. o~/v')c~~~_~.--s (V!... (./C'i..r'n,~.s; L-.T'-L. . -r~'" .
<br />
<br />J~ ,'-i /2:>)#2<.'..5 fro (,./15....-vt.-......- L/~--vf.s,_~ ",_wi I-L..---vc.,.-,Ollo-s;. l"J...ks ~.,. ~,~ ~ Ly)
<br />Ik... c, >i)' . I
<br />EXPERENCE OR EDUCATION THAT WOULD ENHANCE YOUR EFFECTIVENESS
<br />AS A COtA1ITTEE OR COMMISSION MEMBER
<br />/ j
<br />~I ' ... ,.... . (_,,, . t ,~, ...
<br />L- t/e.- ?JOr t~ U-/ rli.- .c:.-t -t- Y / .1....... I VI. (./ ~ I ) I'! (,Ie<.... , 0 (.A- :; C /., -t Ie....,'\.
<br />6- S ~ V ~ ~ t.j /J e vJ ...e r t-c....r 0. l. I'd- ..i ;,,- .J d"{(>--",-~ -r
<br />
<br />j2;~ts o~2 tL/
<br />
<br />SlGNAlURE (~ ~
<br />
<br />DATE 1.2-.. i -o-f,
<br />
<br />Return to: city of Centerville. 1880 Main Street, Centerville, MN. 55038
<br />
<br />~
<br />
|