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<br />~ <br /> <br />CITY OF CENTERVlue <br />APPUCATlON FOR APPOINTMENT <br />Committee or Commission applying for: ~(\if'~. 4- ~\\; ~ <br />NAME: ~{\ L F"~ \(2. {'\b-c..'ne..(' <br />STREET ADDRESS: --, ~ 30 'Pel +=, e..(' C'fC. \e- <br />CITY: u..o(\i-e.r~\ \ \e.- MN ZIP: 5503~ <br />TELEPHONE tkxne Ctbl 7~~ Co\O~ Wort (d5\ 71>4: (olO'O- <br />NumberofY'*S a Centerville Resident I,Z:; Vb>-f$ Fax {c6\ 'd.O-:r 4<r3r <br />Ate you pr8S8I'ltIy serving on a City c:A Centerville Conunittee or Commission? }.JO <br /> <br />-- <br /> <br />Which One? Term <br />Have you served on a City of Centerville Committee or Commission in the past? W <br /> <br />'Nhich One? <br /> <br />Term <br /> <br />YJhich One? <br /> <br />Tenn <br /> <br />What do you have to offer to The City of CenterviIIe Cornmitfee or Commission? <br />:r ~(\ 'o~\~ fA. -9tts~ ~s:~vc- -\t> ~ P4:. Z. <br />Co\'4\fJ'-~-\k t.- . AfvJ.. bc.cav ~ I- wo( \L ~\Y\ ~(VL I <br />. <br /> <br />L 0-('1\ {M),,- \ \,,\Aa.- ~~ -\-h- cj.cA( ~ <br />~~ukA . <br /> <br />EXPERIENCE OR EDUCATION THAT WOULD ENHANCE YOUR EFFECTIVENESS <br />AS A COMMITTEE OR COMMISSION MEMBER <br />KlYt -- F;(Y.4\((.. I U{\~~Jt+y ()-(1- Sf.Iro~s(~s) <br />O~~ ," ~(\{<-+~~, Uw- Lo..C(\)IK- (1~q) <br /> <br />SIGNATURE ~~ <br /> <br />DATE \l/r~/~ <br /> <br />Return to: City c:A Centerville. 1880 Main Street, CenterviUe, MN 55038 <br /> <br />r;71 <br />