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City of Centerville Citizen of the Year <br /> Nomination Form ( . <br /> Name of Nominee: 42- A ria <br /> "uN Arw Phone: <br /> Address: <br /> Ann _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 a listed. Airp.,i /Jj <br /> ❑ City of Centerville Committee: The Local Organization: <br /> / <br /> Local g izati. : Schoo : <br /> ❑ Church: Other: <br /> ❑ Other: 0 Other: <br /> Please list below the tasks that the nominee has accomplished during this .. st year <br /> that have been of benefit to Centerville and its r- sidents:_i / 4 4 <br /> • <br /> / S � <br /> Atallr4rArra/PS-A'AINFth'irrr .• <br /> • , • • <br /> Are there an other factors you feel ma be im sort. to consider re • arding this <br /> 404 -- ■446 41 4 <br /> j / / Atari S 5 P I S MI <br /> 4 <br /> Nominated by Date L� _ Date 0/is-pi Address: �a"`.c•C <br /> Phone: <br />