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TN 1,43 VALLI- -2 ia , 14>ro- <br /> t'se,0 <br /> vtor.,..* s Cc"Iwo.. •'' '01-) <br /> City of Mounds View <br /> 2401 Highway 10 <br /> L-7.(.0'11,0 v11 6i-,?(Tre,ti- <br /> Mounds View, MN 55112 <br /> Phone 763-717-4000Fax 763-717-4019 E") <br /> WWW.Ci mound-,. krew,mr,us <br /> Application for Advisory Boards and Commissions <br /> Board/Commission Applied for: - 4 v,3 0, 1,0 <br /> Full Name(Please print): <br /> Home Phone: 7 C..-)3- -53 ct;3 5-* 3 Work Phone: <br /> Cell Phone: - 9(-7, <br /> Years lived in Mounds View: <br /> Address: -7 k k.: <br /> Erna"!address: b *-\-1 s it,0.0 c, <br /> Qualifications you want to have the Mayor and City Council Consider <br /> Skills and Interests: ?.<2,' <br /> doo v-79 ) <br /> - <br /> 4 t 71;tt'c ttt tt.ct t <br /> !,3 fet:tti• tt.'"\ t,at t't-ttCtt t <br /> Employment,Occupation or other Experience: 1/4,„.fzr C1 V <br /> k'se, is 4- V 4 0,244- <br /> Memberships,Accomplishments or Other Qualifications: <br /> Please state your reason for wanting to serve with this group: <br /> .1c- d,„`. .„ , 4t, <br /> v",`, v vs, "-Ix,- t‘•-• e L-r o <br /> )6, Ni\o‘ Sre,A <br /> Signature: Date: C) <br /> (Your response to any of the above inquiries may be continued on the back of this loan 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 shalt have access to its programs,facilities and employment <br /> without regard for race,creed,color,sex,age national origin or handicap. <br /> • <br />