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<br />~O'/2'/200. 11,12 FAX .517.2.... <br /> <br />---- <br />JAKOBERS <br /> <br />l4I 001 <br /> <br />L::l. . ~ CITY OF CENTERVILLE <br />~ APPLICATION FOR APPOINTMENT <br />Committee or Commission applying for: jJf11k. 0 f) d f !{ 1.r J <br />NAME: ffl~ qa JcMwu <br />STREET ADDRESS: If) 9 7 J /3l1 J a ru 1Jh}. <br />CITY: [;;1111A1Jj ~ li) <br />TELEPHONE Home 11'5 J 1/1)::J - R /( U l.{ <br />Number of years a Centerville ResidentJ 6 <br /> <br />CQrnffut1w <br /> <br />MN ZIP: 5,9J3fj <br />wort( 11)')/ ;)1.f- LSj,\ 14 <br /> <br />Fax <br /> <br />Are you presently serving on a City of Centerville Committee or Commission? () 0 <br /> <br />\Nhich One? <br /> <br />Tenn <br /> <br />Have you served on a City of Centerville Committee or Commission in the past? Il () <br /> <br />Which One? <br /> <br />Tenn <br /> <br />Which One? <br /> <br />Tenn <br /> <br />What do you have to offer to The City of Centerville Committee or Commission? <br />~J fl/IfJiJ} O~ I it & /Jt Ml1illiJ L l.f'n1J) t' /Ylj R J d) , O/l i'Jl rcJ <br />,-JJ1i. paLU1/) 'ary) Offlvi!JiA +Mt ~#rdfjljJi#iL (~t1- <br />aaiWlJil MJ hip~.JL1J.R IIfd-n.Al 'f!J./ tN) pa;ui Md! M:h <br />OJ- <br />~E~ 0 ATION THAT 'OULD ENHANCE YOUR EFFECTIVENESS <br />AS A COMMITTEE OR COMMISSION MEMBER <br /> <br /> <br />SIGNATURE ~ ~ DAlE 1/,;1 I / Q~ <br />Retum to: City of Centerville, 1880 Main Street, Cent9fVille, MN. 55038 <br />