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<br /> <br />CITY OF CENTERvnLE <br />APPLICATION FOR APPOINTMENT <br />Committee or Commission applying for: 1119',cI1/ I ~~ ~ 20 J.J I ;""t; <br />NAME: f?,~ jf (jb1..J) PK~c;c..I- <br />STREET ADDRESS: 70/? D ~ All e Rd <br />, <br /> <br />CITY: ee~p.vltle .MN ZIP CODE: .s:rD38 <br />HOME TELEPHONE:6&-7h2 -,,'2..7.S"1-- WORK TELEPHONE: K <br />FAX: EMAILADDRESS: VhA;;) F-f-4C,; ~A(J~ ilcf-- <br />I <br />Number of years a Centerville Resident?: 712.- <br />Are you presently serving on aCenterville Committee or Commission?: Po <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Have you served on a Centerville Committee or Commission in the past?: 1./0 <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />SignaDIre: J/1~ - ~~ -.., 7. DatI= <br />r <br />C ty Administrator <br />Return to: C:ty of CenterviDe <br />1880 Main S1l'eet <br /> <br />. . <br /> <br />L6 <br />