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<br /> <br />Irn: , <br />I ,.~ <br />lil1 <br />i!'; <br />'iii <br />lJu <br /> <br />'-'--::1 <br />,; .. i.,,11 <br />. \ L:: i Ii 11 <br />!'iin <br />OCi20Z009 l0 <br /> <br />~,~ <br /> <br />Commission/Committee or City Council applying for: <br />NAME: UPMf-r (Lawlr' ^'}~ <br />STREET ADDRESS: 1/ g b I3r I ~ JlA <br />CITY: ~ ,MN <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR APPOINTMENT By <br /> <br />~mt~ <br /> <br />ZIP CODE: <br /> <br />S-s-o~~ <br /> <br />FAX: <br /> <br />WORK TELEPHONE: >r1..f1A-e-- <br />EMAIL ADDRESS: I'LffJJ.eli) ~11 . red- <br /> <br />HOME TELEPHONE: 0'5'l 2/0' 1170 <br /> <br />Number of years a Centerville Resident?: <br /> <br />(q <br /> <br />Are you presently serving on a Centerville Committee or Commission?: ~ <br /> <br />Which One?: <br /> <br />Term?: <br /> <br />Have you served on a CentervilIe Commission/Committee or Council Member in the <br />past?: ~ <br /> <br />Which One?: <br /> <br />Term?: <br /> <br /> <br />Which One?: <br /> <br />What do you have to offer the City of Centerville?: <br /> <br />Signature: <br /> <br />Date: <br /> <br />City Administrator <br />City of CentervilIe <br />1880 Main Street <br />Centerville, MN 55038 <br />