City of Galena
Planning and Zoning Commission
Membership Application
Name: Phone:
Present Address:
Street City State Zip Code
PERIOD OF RESIDENCE:
PREVIOUS ADDRESS:
Street City State Zip Code
PLACE OF EMPLOYMENT
PHONE NUMBER OF EMPLOYER
Reference: Three persons, other than relatives
NAME ADDRESS YEARS ACQUAINTED
DO YOU OWN YOUR HOME?
DO YOU OWN RENTAL PROPERTY IN GALENA?
WHY ARE YOU SEEKING APPOINTMENT TO THIS COMMISSION?
CLEAR
SUBMIT