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City of Centerville Citizen of the Year <br /> Nomination Form /' 7 r 7 . / . <br /> Name of Nominee: i. ?/>L r isrj Phone: 53 -Q 79/ <br /> Address: / FtI7,/OGO /! ( 1r ee (// , IC) <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 /> Sic. - r� J - c��— L/1✓�./ . Fefe c L a c <br /> L 0 ( y C , //c <br /> ❑ Local Organization: % School: �' ' ` r � �" evr r) <br /> \Ache,v, ✓o/C ,fl141f <br /> )i church: `` Other: <br /> G ru - nc C 4,u d t G <br /> L ad, ciel re War r r' 7 }err t l �i1 (P ivi // <br /> d >� � I LeuctXkn 't O /'�Lf.Aicto aposz'•s (2 r <br /> C � <br /> ❑ Other: iv«" s ❑ Other: <br /> Please list below the tasks that the nominee has accomplish0 during this past year <br /> that have been of benefit to Centerville and its residents: (.,(AA <br /> J,, A�. <br /> ,// �t <br /> c- a)12 �9W ryuu cA 6.--1 ii 44�� v c -1 �e c M4-t L <br /> f� <br /> 261 C (icon Cu - Y4',/. ton-eJd -4,07/ ,ht <br /> __ -SA/ ejo ,/6Le tr? /e o f CO M Y)� sc.i . t _ , <br /> S 0 . , - -m &e <br /> • <br /> Are there any other factors you feel may be important to consider regarding this <br /> nominee <br /> Nominated by � , e P rn Date / - / e -Co <br /> Address: / 836 ,&dofr -5/4,6J ( J1C <br /> Phone: (p5I' &63 "5 & /to <br />