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<br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT By_::---- <br /> <br />fF:::--.~ <br />/In'I,r;;; ---- <br />PI IIi) i ! ,0 1,0) '-co .c:---_ <br />u I.::; (!f) I r~ .f I ,;")," r-., ,_ <br />!, "i,c-,.. l,l ]i!! Ie; i "I <br />/ .'1 " .~ '._,1 / C i j1 J <br />Ii i' ( 0'- .~ Ii!:' <br />VI! L I 20 "nO :' (,Ii <br />I.~ {l; 9 ! it / <br />'/;1 <br />U <br /> <br />Commission/Committee or City Council applying for: C/J'-' <br />NAME: 5"'7.Wr."A/ b rr/llEmv7J/ <br />STREET ADDRESS: /ffcJ6 #?R77fJ~e ~~ <br />/ <br /> <br /> <br />.' \)t <br />W' <br /> <br />CITY: UA./TF..e:WUE <br /> <br />. MN ZIP CODE: 5I CJ5 g <br /> <br />HOME TELEPHONE: 057310/ fZ7 WORK TELEPHONE: jQ:-69:1-/.Z;JS- <br />FAX thO 39tN 9Z 7 EMAILADDRESS: ~FR/EJ#W"((! ~.f:"7W((L.CoU/1 <br /> <br />Number of years a Centerville Resident?: / <br /> <br />Are you presently serving on a Centerville Committee or Commission?: A/P <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Have you served on a CentervilIe Commission/Committee or Council Member in the <br />past?: A/c- <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />What do you have to offer the City ofCenterville?: /4CJve ~ A::J ""~ d ~ <br /> <br />~~~~ ~,;d;~~~;;d!avJ~ <br />41'119//2:-- n~ /A;"= ~ -;a?i ~ ~ <br />C?--7I Lf'~/ d/?h;/'LC'/C~ <br /> <br />Experience or Education that would }7Ihance !~ effectiv~es~ as a <br />Commission/Committee or Council Member?: {( t:Jo11tI r"'M'A'.i'~ cw, ,,"7~ ~ <br /> <br />, ~ , ~ <br /> <br /> <br />t.a <br />/- <br /> <br />Signature: <br /> <br />Date: <br /> <br />City Administrator <br />City of Centerville <br />1880 Main Street <br /> <br />/?5 <br />