Laserfiche WebLink
<br />City ofCenterville Nomination Form <br />City rlj Centerville CitizenIBusiness Person of the Year/Lifetime Achievement Award. <br /> <br />Nomination for (please check one) OCitizen <br />Name of Nominee: <br />Address: <br /> <br />OBusiness <br />Phone: <br /> <br />OLifetime Achievement <br /> <br />If nominating someone for the Lifetime Achievement Award in memory of; please list name of living spouse or <br />relative thatmay be contacted for further infurmation: <br /> <br />Name: <br />Address: <br /> <br />Phone: <br /> <br />Please check the organizations or groups this individual is associated with and write the name of committee that <br />this person is actively involved in. If not listed, please write the name of organization in the OTIffiR co.lumn. <br /> <br />City of Centerville Committee: <br /> <br />o Local Organization: <br /> <br />o Local Organization: <br /> <br />o School: <br /> <br />o Church: <br /> <br />o Other: <br /> <br />o Other: <br /> <br />o Other: <br /> <br />Please list below the tasks that this individual has accomplisbed during this past year/lifetime for Lifetime <br />Achievement Award that have been ofbenefu to our City and it's residents: <br /> <br />(If you need additional space, please feel free to attach a separate sheet ofpaper.) <br /> <br />Are there any other :factors you feel may be important to consider regarding this nominee? <br /> <br />Nominated by <br />Address: <br /> <br />Date: <br />Phone: <br /> <br />Nominations tue due by February 16, 2001 and can be placed in the drop box located in the parking lot at City HalL <br />