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<br />G!~~ <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT <br /> <br />Commission/Committee or City Council applying for: C \ + ~J <br />, <br />E ('~ c... ::So Lo-<..s c<\ <br /> <br />STREET ADDRESS: ,.::.. s J <br /> <br />Co...."c.. L <br /> <br />NAME: <br /> <br />1 Srcl <br /> <br />s+ <br /> <br />CITY: C~ nTH...,: n ~ ,MN ZIP CODE: 5.5 0-3 'is' <br />HOME TELEPHONE: 651 4:::Lb ()CUC WORK TELEPHONE: bsl ::L~O~33~ <br />FAX: EMAILADDRESS: ~os \....r-S.c<\Ql )'......\.-DO, C,c:."" <br />Number of years a Centerville Resident?: I " <br /> <br />Are you presently serving on a Centerville Committee or Commission?: <br /> <br />f'lo <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Have you served on a Centerville Commission/Committee or Council Member in the <br />past?: \\ 0 <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />What do you have to offer the City of CenterviIIe?: ~ \ (- .... < f'. s;: "'f'. <br />0... \-+-.... ,--\r-("-J ~\--.~~ i--s <br /> <br />Experience or Education that would <br />CofmnissionlCommittee or Council Member?: <br /> <br />enhance your effectiveness <br />\> \t'-....<; f" -Sl'-of'- <br /> <br />as <br /> <br />a <br /> <br />~_....\.. .5.\..."~, cts",,,,,,~. c-."...J "",: \~~ r~'\J~' <br />.> J <br />I. \ oc'\:. fo~ .......('~ -t.; ~ O\1~{"-\--"'~:\) -\. Co <br />. \ \ <br />'n( C-~Io\fc' 'r., S~_\ -<i1 <br /> <br />Signature: ? <br /> <br />Cb..t <br /> <br />. I <br /> <br />- <br /> <br />Date: <br /> <br />)u /:2/ /09 <br /> <br />Return to: <br /> <br />City Administrator <br />City ofCenterville <br />I 880 Main Street <br />CentcrviIIe, MN 55038 <br />