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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: <br />Full Name (Please Print): KI 1LNAR3 A GLt N DAN L <br />Work Phone: <br />Work/Cell Phone: G12 - 21 2 <br />Address: ) 11% La tN��) U'� L1 M <br />Years at this address: �_ Years you have lived in Mounds View: I vatru 'yam <br />E-mail Address: <br />Experience and Qualifications <br />Skills and Interests: Ci+ imp `ct D ���\� 11. E Z �, - dL� �- <br />(o QQ_WNI��� I 7� C7P» C�\'i�dJQ�' 4� /-\"16 Ail, I! CT \\5\T f S <br />Employment, Occupation or Other Relevant Experience: \3 S N+w\� CT <br />L SA � rt �11� Tib K dNU' r 'rnz`li� J �\LS 1 0 <br />MembershiCp�s, Accomplishments or Other Qualifications. <br />t%� <br />Please f�at� your r a or of anting to se ve with t�iis graup " G' ' N �n i >J 06 <br />r "sem �'�' S t;D_\)� \"'� �§j pt\�`N i�� t TSL Ci\\t�1R�d IvA <br />Signature: �-7-7 -,4 _ Date: <br />(Your response to any of the above inquiries may be continued on the back of this form and you <br />may attach other information that you would like the City Council to consider.) <br />The City of Mounds View is committed to the policy that all persons shalt have access to its programs, <br />facilities and employment withoutregard for race, ethnicity, sex, age or physical abilities. <br />