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City of Centerville Citizen of the Year <br /> Nomination Form (c cj � . <br /> Name of Nominee: 4 S' `Q Ler.e Phone: <br /> Address: rent <br /> I 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 /> 1 C'ty of Centerville Committee: /Local Org nizatio <br /> Local ni t ❑ School: <br /> ❑ Church: ❑ Other: <br /> /Other: ❑ Other: <br /> Please list below the tasks that the nominee has accomplished during this p. s year <br /> that have been of benefit to Centerville and its resident • • j/ / <br /> 4 di i • i..L� �',.�' <br /> / //. " �'/ �.�� .� III/ aI �, ./ / ' <br /> ]/ e // � i <br /> AL.n....1f' /� �j �� �I4� �I�: � /:ai.a- —/ a. /' / Iw /V/ <br /> of <br /> e there any other factors y. f- el may be important A. con / der regardin !this <br /> nominee 1 -/ i4 �/ j n , <br /> Nominated by - "Si_ Date / /.S /00 <br /> Address: Ale <br /> Phone: <br />