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<br />~tervif[e <br /> <br />'.. 'L<ta6fislieJ lSS: <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT <br /> <br />( FJJ4) <br />De I/e !D;J />1~"f- 44 -Mn/)17 <br /> <br />Committee or Commission applying for: Ec O'^ 0 ......, .' L <br /> <br />NAME: Je YI '" Y D05 c..-A. <br />STREET ADDRESS: 7'D q 5'" (. o-l/or1 woo 6J [f-- <br />CITY: Ce >1 +f'l/ // Ie , MN ZIP CODE: 55""c:::53lf' <br />HOME TELEPHONE: yo 7 - c; q"3 6 WORK TELEPHONE: 6 /2- / 6sc;-7 2- Y9 <br />. <br /> <br />FAX: h ')1 jL/O'/- 913b EMAIL ADDRESS: -d -- cl C.5Jg 1'1.1 ~1'1, LorYl <br />9 <br /> <br />Number of years a Centerville Resident?: <br /> <br />Are you presently serving on a Centerville Committee or Commission?: No <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Have you served on a Centerville Committee or Commission in the past?: Yf .5 <br />CJ,~bl4"Jt") Term?: 5' mOJo <br /> <br />Which One?: <br /> <br />[;DC- <br /> <br />Which One?: <br /> <br />D'Dwl\ -fo1Al1' 7"-5 JC.. For t~ <br /> <br />Term?: <br /> <br />3- <( ~D5. <br /> <br />What do you have to offer the City of Centerville J5 a Committee or Commission <br />member?:. r 11.41/,( ""~J ~~ b-l2( ~ ~ J-1cfU'4/~ <br />V~ .vl.v.) "1 <br />~ /1 ()...G(, ()~-t-IS- 1 (-F/~ /D 1e.<J . ;11o~f- Ph -ft.oK ;:'O'7I:;"~ <br /> <br />W~ fY' oV /J /" 5 ..,L, '.1 a-v.. c , \~ ~ Of "... ~,'.:rv-- -ft) S ~cn 7- )/'V'. ~ t:J&. ~ <br /> <br />~.'jl'orl /'V'1cv1['A) ~ rhDb''7- 5,:/--'tq;h~. Add,'-Ir'Cr7~ r :r ~ <br />~ '5 -/-q k- 1o.L>/ ~ ~ ~ ~ vv+w-..r dt. /I.t..I Of' ~ + ~ ~ & ^-f7 (c i/~ <br />Experience or Education that would enHance your effectiveness as a Committee or <br />Commission member?: <br /> <br />Ct,AU-l,<.+ .::G~.' 4~~,'5.fa",-r frD-tt-s$"'- ~ M~"'1A7e- ~N+- /l-cco~;l'J......" <br />C J'2'1e -f-dI'DI,'-fAr1 )fr.~ tJ",lrr'.. <br />/Vl.iI.7.4- - C,'-'\aI1Le /)..,'//. 5""./11~-1l>I~) <br />/ <br />J3 I) If - 4- c ( () 1./ YI ;1-, (.. 5 [ ~//J , :rGJ~1 <br />/b ~1..v\4 L-t/""'\~,^-6/H ~c.c.~ ~ JC/',,_ 't.J .(..J(~,I_t...JL <br />Signature: r tJ..-&. ~ Date: J , <br />va- ~I tDf ( Z. ~D7 <br />Return to: City Administrator <br />City of Centerville <br />1880 Main Street <br />Centerville, MN 55038 <br />