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CITY OF MARTINSVILLE INFORMATION FORM <br /> <br />FOR APPOINTMENT TO CITY BOARDS, COMMISSIONS AND COMMITTEES <br /> <br /> ***Please Print or Type All Answers*** <br /> <br /> (If married, please give spouse's first name ^) <br /> <br />, ~/? //,.--..4-.:~ ~_~._ ra ~- <br />Residence Street Address <br /> <br />Martinsville, VA 24112 <br /> <br />Mailing Address <br /> <br />, ;W//~','',4 ,, ~ ,~ : l /--- <br />City <br /> <br />TELEPHONE NUMBER: <br /> <br />~¢//~ -- <br />Zip Code <br /> <br />Business <br /> <br />OCCUPATION/EMPLOYER NAME: <br /> <br />CHOICE OF'COMMITTEE:, '~'¢~'"¢'/"'¢£u.'//-,. <br />PLEASE PRINT OR TYPE HERE why you would like to be considered for <br />appointment to this committee and what particular qualifications you <br />feel you have: <br /> <br /> <br />