Laserfiche WebLink
JUN-12-~001 12:26 YOUNG,HASKINS, MANN,GREG. 540 638 1214 P.00~00~ <br /> <br />CITY OF MARTI <br /> <br />FOR APPOINTMENT TO CITY <br /> <br />***Please <br />(If ma~ied, please give <br />~-~'E~en&e Stz-eet A~res~ <br /> <br />Martin-~ville, VA 24112 <br />Mailing Add=ess <br /> <br />TELEPHONE NUMBER: <br /> <br />Home,,, <br /> <br /> Business__ <br />OCCUPATION/EMPLOYER NAME: <br /> <br />c~ozc:s oF co~:r~: <br /> <br />PLEASE PRINT OR TYPE HERE <br />appointment to this committ <br />you feel you have: <br /> <br />RETURN TO: Clerk of Counci <br />24114, NO LATER THAN <br /> <br />Date Received (to be complet <br /> <br />NSVILLE INFORMATION FORM <br /> <br /> BOARDS, COM~ISSION$ AND COMMITTEES <br /> <br />it or Type All Answers*** <br /> <br />odse'~ first na~e t) <br /> <br />Zip Code <br /> <br />ty you would like to be considered for <br />ee and what particul'ar 9ualification~ <br /> <br /> (please continue on back) <br /> <br />· P. 0. Drawer 1112, Martinsville, VA <br /> <br />TOTAL P. <br /> <br /> <br />