Laserfiche WebLink
__ 9610212003 11 20 7946623369 $IHPSON PAGE 02/83 <br />-RECE'tVE'/] JUf',I 0 2 <br /> <br /> CITY OF MARTINSVILLE INFORMATION FORM <br /> <br /> FOR APPOINTMENT TO CITY BOARDS, coMMISSIONS AND COMMITTEES <br /> ***Please Print or Type All Answers*** <br /> <br />(If married, l~leas~e give spouse's first name t) <br /> <br />Residence Street Address <br /> <br />Martinsville, VA 24112 <br /> <br />Mailing Aadress <br /> <br />city <br /> <br />TELEPHONE NUMBER: <br /> <br />Business <br /> <br />Zip code <br /> <br />CHOICE COMMITTEE: <br />pLEASE PRINT OR TYPE HERE why you would like to be considered for <br />appointment to this committee and what particular qualifications <br />you feel you have: <br /> <br />RETURN TO: Clerk of Council, P. o. Drawer 1112, Martinsville, VA <br />24114~ NO LATER THAN <br /> <br />Date Received (to be completed by Clerk of Council): - <br /> <br />3'UN-02-2003 11: 22 '7046E,2336B 97Z P. (32 <br /> <br /> <br />