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<br /> <br />, ID <br />iJ'lA. <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT <br /> <br />Commission/Committee or City Council applying for: u'<!\C--,q;.:> { c..o".->c..i t. S [JII-r- <br /> <br />NAME: <br /> <br />77l0"'.A.:s. <br /> <br />VJ ; LJ./ IHc_f3 c./c <br />CoB '19 &"J-r~I.I~LL.E <br /> <br />Rd <br /> <br />STREET ADDRESS: <br />CITY: ~c,:)TE'.tZ-ul'-'~ <br />HOME TELEPHONE!1;,.s-I)Y'.,'l9-o'<l '/ tJ <br /> <br />. MN ZIP CODE: 5S638 <br />~TELEPHONE~S-J Sf 7- /~S-6 <br /> <br />FAX: <br /> <br />~. <br /> <br />EMAILADDRESS: -rpLPh.f!fJ.T<8tJ?. (P7~.MSN" C-b"^- <br /> <br />Nwnber of years a Centerville Resident?: 'Ii) <br /> <br />Are you presently serving on a Centerville Committee or Commission?: <br /> <br />;Ub <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Have you served on a Centerville Commission/Committee or Council Member in the <br />past?: f'as <br /> <br />Which One?: -p -f- Z <br /> <br />Term?: <br /> <br />S t5 e A rr /l4.Il9:J <br /> <br />Which One?: ~ cJ.u c,"L <br /> <br />Term?: <br /> <br />1<' <br /> <br />,t<. <br /> <br />What do you have to offer the City ofCenterville?: S~~ A71J,c.J,I~ <br /> <br />Experience or Education that would <br />Commission/Committee or Council Member?: <br /> <br />enhance <br />sa:. <br /> <br />your effectiveness as <br />A 717f C-)J b xJ <br /> <br />a <br /> <br />Signatur~.-/~ <br /> <br />Date: I 7 DcT 0 'j <br /> <br />Return to: <br /> <br />City Administrator <br />City of Centerville <br />1880 Main Street <br />Centerville, MN 55038 <br />