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<br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT <br />Committee or Commission applying for: 1> ( Q.t\ VI 1 ~ + 7 n Vii n J <br />NAME: S CLvv\ e.s lA) ~'K S~:i:b <br />STREET ADDRESS: I 8 3 ~ ~)J( ~(j, y) <br />CITY: C.P/l frf\llJJ .t? <br />TELEPHONE Home ( D \ ~ ~ 8 B Cj - 3 I ;A';)" Work <br />J <br /> <br /> <br />MN <br /> <br />ZIP: CJ5 0 ~ p) <br /> <br />Number of years a Centerville Resident <br /> <br /> <br />Fax <br /> <br />Are you presently serving on a City of Centerville <br /> <br />mmittee or Commission? <br /> <br />l\l ~ <br /> <br />Which One? Term <br />Have you served on a City of Centerville Committee or Commission in the past? N 6 <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 /> <br />30 <br /> <br />~-Iu:n <br />~A/U)h(l{&a ( ~dhiJ~ cd- 'aJ ~ <br /> <br />EXPER~OR EDUCATION THAT WOULD ENHANCE YOUR EFFECTIVENESS <br />AS A C6MMrnE OR COMMISSION MEMBER t' <br />?r . <br />00 . QA~ ~-1 . :..{..A/,.bl.I1--.1'A--O <br /> <br /> <br /> <br />DATE lojJ3/;;"CVg <br /> <br />Return to: City of Centerville, 1880 Main Street, Centerville, MN 55038 <br />