Name of
Nominee__________________________________ญญ____________________
Address of
Nominee____________________________________________________
____________________________________________________________________
Name of
Nominator___________________Phone____________________________
Address of
Nominator__________________________________________________
____________________________________________________________________
Summary of Qualifications: (attach separate
page if necessary)
Community
Involvement________________________________________________
____________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Clubs and
Organizations_________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
Local Government
Involvement___________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Special Projects or
Events_______________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Outstanding Citizen of
the Year Committee
114 East Broadway
Mt. Pleasant, MI 48858
Return by January 4, 2008