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CITY OF MARTINSViLLE INFORF~TION FORM <br /> <br />FOR APPOINTMENT TO CITY BOARDS, COMMISSIONS AND COMMITTEES <br /> <br /> ***Please Print or Type Ail Answers*** <br />(If mar~-~', please give spice's first name $) <br />Residence Street Address <br /> <br />Martinsville, VA 24112' <br /> <br />Mailing Address <br /> <br />city <br /> <br />TELEPHONE NUMBER: Home <br /> <br />Zip Code <br /> <br /> Business <br /> <br />REFERENCE: I )~ ~ /~,~' <br /> <br />PL~SE PRINT OR TYPE HERE why you would like to be considered for <br />appointment to this co~ittee and what particular ~alifications <br /> <br />you feel you ha.ye: -- . <br /> ~lease continue on back) <br /> <br />RETURN TO: Clerk of Council, P. O. Drawer 1112, Martinsville, <br />24114, NO LATER THAN <br />Date Received (to be completed by Clerk of Council): ~/~/~ <br /> <br />VA <br /> <br /> <br />