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<br /> <br />City of Centerville <br />Best PraCtIces Application <br /> <br />Bu8I.... AddM _ss: <br /> <br />1f)"~ ~~. $_ <br />~'" \\..- <br /> <br />......... Phone: t,~ \ 1P6 ~'L <br /> <br />AD ownena and UfRH...... manager& pis.. sign. dale, and pnMde a.... <br />phone or other ndIIIbIe ~d8Gl number. <br /> <br /> <br />I &.1 D1 <br />Dale <br /> <br /> <br /> <br />1I5~ <br /> <br /> <br />IIgnabn <br /> <br />Date <br /> <br />Phone <br /> <br />For the CIty of Centervllle <br /> <br />8IgnaIure <br />ChIef of Police <br /> <br />Date <br /> <br />Phone <br /> <br />8IgnaIure <br />CItr AdmInI8tndor <br /> <br />. Date <br /> <br />Phone <br /> <br />.......... <br />Mayor <br />Licensed est8bII8hrnant8 that choose not tD parIIcIpale In the Best Patdcel U21 <br />PmQ.am or 818 found In 4oIe1IoiI for a third time wID t'oBow the reguI&r penalty grid. <br /> <br />Date <br /> <br />Phone <br /> <br />69 <br />