Laserfiche WebLink
<br />(i~= <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT <br /> <br />)f <br />~'j <br />(1~ Cn~ <br /> <br />NAME: <br /> <br />Commission/Committee or City Council applying for: ('~~,~Jt.. <br /> <br />c?SJ. ~~ <br />/953 -X 1~ I~. <br />CITY: (l4.~.,;aOq . MN ZIP CODE: 55 ll3~ <br />HOME TELEPHONE: &,51- 'I r!l9 - 'l9?'7 WORK TELEPHONE: to 6/- 3'" s -?;'Jot:, <br />FAX: EMAILADDRESS: D, Love. C ~TVC $ta.H. fi.\"'.....(oJV\ <br /> <br />STREET ADDRESS: <br /> <br />Number of years a Centerville Resident?: <1 dUMA <br /> <br />Are you presently serving on a Centerville Committee or Commission?: <br /> <br />t~ <br /> <br />Which One?: J~ ~ 2:fJ Term?: S ~P-'"" <br /> <br />Have Y01kerved on a Centervi e Commissio 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 /> <br /> <br />What do you have to offer the City of Centerville?: <br /> <br />. ...0.:, <br /> <br />Experience or' Education that would <br />Commission/Committee or Council Member?: <br /> <br />your <br /> <br />~.9 L dW.. <br /> <br /> <br />( <br /> <br />..- <br /> <br />krq,. 7~ ~tn<lAI7d<J -V,t~ ~ ~ ~-T..-ra.,,;.'v. <br />Signature: ~. ~_ Date: IDlb lo? <br /> <br />Return to: <br /> <br />City Administrator <br />City of Centerville <br />1880 Main Street <br />Centerville, MN 55038 <br />