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1 <br /> - 7 a <br /> • <br /> onikum City of Mounds View <br /> 2401 Highway 10 <br /> lER7 Mounds View, MN 55112 <br /> .Aon Pty-Pattncrih4. Phone 763-717-4000 Fax 763-717-4019 <br /> www.ci.mounds-view.mn.us <br /> Application for Advisory Boards and Commissions <br /> C.7) <br /> Board/Commission Applied for: Lo,1409,,L`c �, r� lU � (-Ont411 <br /> Full Name (Please print): G-r'e.t3Q 7 (3 tax,„._ Re_1,11'rl <br /> Home Phone: 615 f- (O�—Ca '{Q (O Work Phone: 7(03— G <br /> Cell Phone: 6 57 S 3- ca.) Years lived in Mounds View: <br /> Lach'it <br /> Lr� Address: _`x-3702 e.cr aQ{� �C� �-C'_ Iry rhAI _ .. <br /> TS.1 2 <br /> Email address: Gi rC ee3 GS 1tv - tt 0- i C O s <br /> Qualifications ou want to have the Ma or and Ci Council Consider: <br /> Skills and Interests: (awn ek y 4vsrA �� dti f f�--Arm ,Vi' s,) !S-2,0 es -- <br /> a. 9( d4oc'/t ottic, a6: Ado Cr' (.s lr) - EJoy <br /> Pa 4 c:., / 6'r , C v-e. - <br /> Employment, Occupation or other Experience: <br /> 'tv t�r*AA? C-44%,-0 p At. 50.--1- - <br /> Memberships, Accomplishments or Other Qualifications: C,4 ,rev <br /> r, Af-s-t-- C /14..,4. ®-- P- s,c6,6i - bs-GA. o- <br /> Z. � c• G,{ s.- c✓ /i 8'-- <br /> Please state your reason for wanting to serve with this group: <br /> 70 s-e.e con 41 ft.e -9.0777.4.444._ i n <br /> 001-4=40,C6. 741,ed vim- P41 •7 e._ C.16-0* <br /> Signature: Date: f(--A /—Of' <br /> (Your response to any of the above inquiries may be continued on the back of this form and you may attach any <br /> other material that you would want the Mayor and City Council to consider.) <br /> • The City of Mounds View is committed to the policy that all persons shall have access to its programs, facilities and employment <br /> without regard for race, creed, color, sex,age,national origin or handicap. <br /> II <br /> II <br /> r <br />