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City of Centerville Citizen of the Year <br /> Nomination Form <br /> Name of Nominee: Phone: <br /> Address: <br /> Please check and write in the name of organizations, groups, and committees in <br /> which the nominee is actively involved i.e., city council, parks & recreation, planning & <br /> zoning, EDC, Centerville Lions, Centerville Parents Association, Boy & Girl Scouts, Church <br /> committees, School involvement etc. Use "Other" for any not listed. <br /> ❑ City of Centerville Committee: ❑ Local Organization: <br /> ❑ Local Organization: ❑ School: <br /> ❑ Church: ❑ Other: <br /> ❑ Other: ❑ Other: <br /> Please list below the tasks that the nominee has accomplished during this past year <br /> that have been of benefit to Centerville and its residents: <br /> Are there any other factors you feel may be important to consider regarding this <br /> nominee <br /> Nominated by Date <br /> Address: <br /> Phone: <br />