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<br />~<~,."~' <br />"(y, . e <br />~ <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT <br /> <br />Committee or Commission applying for. #' ft <br /> <br />NAME: i-~vdJ /0//I;~ <br />STREET ADDRESS: ,7/?5' ./JJPUI1t1 ://ct I) <br />CIlY: L/ /lot? f:q,10 ~' MN ZIP: >5-0.7 F <br />TELEPHONE Home c;,.5~ /~ 017-?3 PO Work C;; /;2 -,;< b 9- .s71 S' ~ 5 <br />Number of years a Centerville Resident / ;? fP t; I' J fax ? / c7 - P,?s -S;;<s G <br />/ <br />Are you presently serving on a City of Centerville Committee or Commission? /J~ <br /> <br />Which One? <br /> <br />Term <br /> <br />Have you served on a City ~ Centerville Committee or Commission in the past?~ <br />Which One? ~/J/J/~ J,. 7eA/~~Term "?Y/'50; <br />VVhich One? Term <br /> <br />What do you have to offer to The City of Centerville Committee or Commission? <br />~/14~[jJ ~J1/ Hut/If ~ 5/nc.-.// Ala}"/ <br /> <br />rc2/l-k/'5 //J' c-~/Il-e/I/r' lit , L-4'/!~~ // u/ /J ~ fi!.. <br /> <br />)/t'9/'f ~ e.yt'/';'t/lcZ wCJ/'0i:; h/II-;, /Y//lI}/ <br /> <br />~ ~~12. ,(41'/ -7/-.<//7(/'1 //7 ~*./'t//11f . <br /> <br />EXPERIENCE OR EDUCATION THAT WOULD ENHANCE YOUR EFFECTIVENESS <br />AS A COMMITTEE OR COMMISSION MEMBER <br /> <br />g:~ //1 -~. (I, ~AJ/'/l1'5~. 6rC7V <br />" v / <br />u./ cf/; Ao/J/e' C7/) Ar.,recr f ~ <br />, %:{" ~ ~ wA- I <br />U/J-re~t//hf!, ~/ Tt? el!. 4'ndl tA//)/t! ITS" cA~f!Jt/lfI!5 C1/2(!, ' <br />SIGNATURE "'~~~/ DATE /;;~~ 7 . <br /> <br />Return to: City of Centervil ,1880 Main Street, CenterviIJe, MN 55038 <br />RECEIVED <br /> <br />MAR 2 1 2007 <br /> <br /> <br />CENTERVILLE, MN <br />