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MOUNDS -VIEW <br /> City of Mounds View <br /> 2401 County Highway 10 <br /> Mounds View, MN 55112 <br /> 763-717-4000 <br /> Application for Advisory Commissions and Committees <br /> Group(s)applied for: Cc c D-4‘JC )opfrk,)f C„ n/ <br /> Full Name (Please Print): i t S c GLC G/'l o f <br /> Work Phone:(..SS/" ),`3 0 • Wor )Phone: Col Z-7 7 O-C05- 3--- <br /> Address: <br /> 0SSAddress: -7 H }-/t,,, / C /t1 frItu,ds l/r'e w , M N SJ ll,� <br /> Years at this address: /oZ Years you have lived in Mounds View: — <br /> E-mail Address: J N t.0 it 1`10 E.. l,J.-e s 4e r+v barJ k. c M <br /> Experience and Qualifications <br /> Skills and Interests: r N c. e , 5 p'- r+5 , M w F,S l�; fi T���e I. <br /> Employment, Occupation or Other Relevant Experience: <br /> Uz c 6_ a,r{S: �,.,t- of ,r lc13,1:,Lsr <br /> VC /. t o f N`t.- 1r;�c v c C s s w e St r.f.'LA_ ,L Mc: c.az <br /> Memberships, Accomplishments or Other Qualifications: <br /> (110,) a s %J e w t-DC. - Rus; vs- A 1,)^c cryiY- ' <br /> CC..ur - e„,,d (fier+.i S.er <br /> L 1.' Lc-k-c t C Lac c C&r l'ii n- .rr: lc.r S L Q L <br /> Please state your reason for wanting to serve with this group: <br /> t 4-0 L t c U,-a,L. , "� s-Q l 17 r s -e x( <br /> -I.0 ( OJI c i <br /> Signature: �� tV (i Date: <br /> (Your respo se to any of thea a inquir ies may be continued on the back of this form and you <br /> may attach o r information that you would like the City Council to consider.) <br /> The City of Mounds View is committed to the policy that all persons shall have access to its programs, <br /> facilities and employment without regard for race,ethnicity,sex,age or physical abilities. <br />