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<br />06/12/01 TUE 12: 47 FAX 612 7S4 0082 ~RCLE PlNES-LEX_PD _ -2~~?V CITY HALL III 003 <br /> <br />JUI"l CIS ell os~ 1S>!!! 't.1"'8C1.wind.. ~dv 651491609':;-- - -_ _"__ <br />F.2 <br /> <br />~f?OM t CENT <br /> <br />prroNe NO. 551 42Sl W9 <br /> <br />May. J0 2G0t 12:J5pM?7 <br /> <br />~' <br /> <br />!\'is: <br />PAI]) : <br />~iO!tP'!' ,. <br /> <br />T~AN5IENT ME~CMANT, F!U~~!~ lNl0RMATIO~ SHIEr <br /> <br />In en effort to ~~ovid~ the p~blic of the Cl~~ of C8nt~rville <br />....ith the bellt ql.l~.lity ot 11tl;: ~Ii'thil'l ib '~~ll'~o~.~e City rd..m\.t.... <br />~h. 01tV h~~ d~termin.d th~t th~ f~11o~ini infor~ation h~ <br />reo~ivQd from ~n, an~ ~ll p~rGons or firms wlehini tQ oonduot <br />ck\or-'Go-dvol' Ollale:! ..me/or GQtHl'l.!l' IJp ~ t.~IDNll'al"Y 8sles !it~: <br /> <br />1. NaJtlC and >le!!lo.:;t'!j;Jtiofl of .i?.I'hc~nt: (If' m\Jf" th4n eM pe.sol1 <br />~i;t.ach thll follnw\ I'll( .tl,f"t"lIlath~n on :l nel>t\rate ehlile:'~) <br /> <br />~~~~: _ ~~~Vl~~j" L~){-er <br /> <br />.0_ .~ r ~'19Ii <br />!1;;,"esl LJ""oq,A'l Hair; Heicht: ~- "":;,/#Oc-/. <br />Wei"ht &: cuild: Z~ , ,.".- Da~o$ of Birth: ~I /9 f',s- <br />:Dl."iven t,t~en8~ lS~ ,~,,7,~~"''7 .'>,{.t)_",;/~~.. ~_,_ <br />rl1~~11J~1e (;(jJ;lY of D. !,. <br /> <br />~. f'er-I1l.IHInl. HOl'lle Add~=IIl~: l... ~.3.s: .s......ln"'Ia~.~..&"~ __ <br /> <br />~~PM~I/C <br />t...teo 'oE /)("!,,~~panQY ~ _ ~:: ~~._- <br />Telephone Nl.lmbl/lr; __.~~/- 7~.~-O,."t J.- - . <br /> <br />2. <br /> <br />D~tee Qf Qcc~panc~ <br />TeJ9phone NU~oQr: <br /> <br />........-.----~,.... <br /> <br />.._-~ <br /> <br />:l. -'-~_____. 'I'l <br /> <br />Date~ of Clr;;CIJPl!lllCY <br />']',,1 Qpho,..e lilutlt'o~t.! <br /> <br />-----11_- ..~........._____ <br /> <br />"'-'--~...............-..., -,...--- <br /> <br />--., <br /> <br />4, <br /> <br />.......------..-, <br /> <br />!J.to$. of ClcCllDollnCy <br />T.1.l!1Jh~~tl>i NUJllbo~.; <br /> <br />~IN.__. <br /> <br />5, _.. <br /> <br />---."'-. <br /> <br />DOiit.e; ot ()eC\.IlHlrtcy <br />Te~.~hone ~ijmbtr: <br /> <br />----A:...._______ <br /> <br />-.' <br />