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City of Centerville Citizen of the Year • <br /> Nomination Form /' T j � - <br /> Name of Nominee: , m/i /2;1( hp Phone: 1,51-(c5? - 0 77/ <br /> • <br /> Address: i r / / ,I 'L �/� ' 2 <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 /> Z City of Centerville Committee: Local Organization: <br /> A i ' - ' ' << ,Gl-f (! AUJ <br /> ,4 For E tC, <br /> ❑ Local Organization: School: <br /> -.1.' _ '14 1 <br /> g G <br /> 5( Church: 5t Can ZU uure- ❑ Other: <br /> P, u h Formatao <br /> X Other: ❑ Other: <br /> (tons <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 /> fl ' a A'.` A. '.• I dh r/ . 4 e i If .• • 4e <br /> - JurbttIiJiq - ,Liu miry- Ana) l,Unatnr+tiP bevti ±0 foil Liduzel <br /> A' /. J. ,u .:� tel a , r at i Lit ill len <br /> I$h11.. _ �, �� . .., , �r l.. / et . <br /> i � ►rte i 1 ( . <br /> l il <br /> • iteaz <br /> Are there any. other factors yo feel.may be im .ortant to consider reg. ding this - 7 <br /> ominee I ' /L..:.. _� — _ it 0...L 0 / I.' "I - • <br /> �d IGT�T uW7liiI I_' ii• / i_' ._' <br /> ,,/,// " Pale <br /> l eeee <br /> ct, alp /, A . •)a . ! woo rn y cep <br /> Nominated by SA , _ , . .t Date? - to/ - CO <br /> Address: /845 0, J i r 5t (PS/LA /Jib b /P f ,t)5,8 <br /> Phone: (L"/ -1 /677)1,5 - 9 _ <br />