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City of Mounds View <br /> 2401 Highway 10 <br /> .A t_T._ Mounds View, MN 55112 <br /> ar�t _Parine0\4' Phone 763-717-4000 Fax 763-717-4019 <br /> www.ci.mounds-view.mn.uS <br /> Application for Advisory Boards and Commissions <br /> Board/Commission Applied for: £ DC <br /> Full Name (Please print): )AC-(;(1 I i N C Et,' "T-S iii (e E} <br /> Home Phone: '7(0 5 - 7 BC)-_ '7 16,o Work Phone: ( I a 3 40 - O 7 3 7 <br /> Cell Phone: (014 - 0` `7 {'7 8 Years lived in Mounds View: I 9 r <br /> Address: i7 9 5 '4 I- O tea (4 Z. Kms_ R K (4 D <br /> Email address: .j t c'_Ki e -tS e Conic <br /> Qualifications you want to have the Mayor and City Council Consider: <br /> Skills and Interests: Wo r 1L (� �V 'i (,C,u, ire cut U_ci l lc- C)-f 1 Ire-- , & <br /> • pr,,s -h n vvef- 44-\ �P_s ) L <br /> -f -4-�c !��' f rest p^+ cl..0 , , rt-, v h__/n_m �- C l 4 c -r-ee I <br /> `-t-4_ &'a t (11 (fin S Viet, s ( �/'f' 1 ( ( ()i t <br /> Employment, Occupation or other Experience: , , y"e(►r.`; 0 +r\J <br /> r a.s d. r- ' r° - -t-- r A. ( <br /> Cro r►' C O l .t'C,C u S- . (rl h r v i v -es S W n r iC_ C I 0 Si- I ( t+N--fn r R <br /> 80A-or ID c) hire c..` rS er1( nur1n61 t'r, h nr -i / ruts 1-0 at-LP. <br /> LG ry,m c.._n <br /> Memberships, Accomplishments or Other Qualifications: re r 1i d + n Pr opt' <br /> t��c9 m1 c-1,5e+m .1- r\ci fa i r'- 1-to Li, S'+ n is , ' �v c, <br /> r1 v <br /> Support- Cor %cops" (',.rt�v��Z c� r1S My_ nvOS"t" I rV�l7drtC:r-f- <br /> aC ( u y ISS h me�'�� 15 kcyvi i,� rCd t 4, c{ 0. SCS,n C GLC <br /> �� r\ r S c Ifes, , i 5 cif-f-' 'f o C c ((t e_ C?„c{ C a... v (.(Q 4`3 <br /> Please state your reason for wanting to serve with this group: rn <br /> rrto- <br /> W I TH H EDTro 1.1 I C. TtAk 1 ivt Cd P . 1G1 r Li( m i_. �+-i `1 Ebc: p(C LAd. <br /> �1t'C C U r lib C Fi i I, L— '-i-'lc Opp()f-itc ny <br /> t_C.) ri( O aihi.7) jrcL c� Cat-1.—k Mere__ rti �-�-.rGr��-e.rJ l" OW-- MV <br /> <J �� �J <br /> Signature: Date: <br /> • (Your response to any'o a 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 />