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<br />. <br /> <br />. <br /> <br />. <br /> <br />City of Mounds View <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />(763) 717-4000 <br /> <br />wJ-/~\ (~JY de I.rv- <br />[,v-pV110 ~ <br /> <br />Application for Advisory Boards and Commissions <br /> <br />~ ~ . <br />Group Applied for: ClvtrrVt L~~ <br />Full Name (please Print): (Javu tJ ~ <br />Home Phone: 703 - 7%'1- d9cX 9 Vwork Phone: ;(l ~ <br />Address: JJ/;;J ffaduJo(')d 12d, ml'JtlAI~ Z)~ J!2JJ.55//.;2 <br />Years at this address: / j Years you have lived in Mounds View: 3 t./ '1MJ <br /> <br />E-mail Address: <br /> <br />~, <br /> <br />Qualifications You Want to Have the Mayor and City Council Consider: <br /> <br />Skills and Interests: <br /> <br />Employment, Occupation or Other Experience: <br />~vv~ -.26 ---y..L-~ <br /> <br />Memberships, Accomplishments or Other Qualifications: <br />~ ~~-x-t, i J'~'7 ~ t:1~ ~~ <br /> <br />Please state your reason for wanting to serve with this group: <br />(!A/Y~ d~ <br /> <br /> <br />/' ' <br /> <br /> <br />Signallrre:(!.J..t/~~~ Date: {./c -~~ <br /> <br />(Your response to any of the above inquiries may be continued on the back of this form and you <br />may attach any other material that you would want the Mayor and Council to consider.) <br /> <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, creed, color, sex, age, national origin or handicap. <br />