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iii 1.i_. <br />MOUND <br />City of Mounds View <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />(763)717-4000 <br />APPLICATION FOR THE STREETS AND UTILITIES ADVISORY COMMITTEE <br />Full Name (print) �pn t� �i < ()n <br />Home Phone 763- 7 SO - B 8�Q Work/Cell <br />do <br />Years at this address / 6 Years you have lived in Mounds View 23 <br />Email <br />QUALIFICATIONS YOU WANT TO HAVE THE MAYOR AND CITY COUNCIL TO <br />CONSIDER <br />Skills and Interests O u -Noor oc ili�P,he5� G QPLIA <br />Employment, Occupation or other <br />Memberships, Accomplishments or other qualifications <br />Please state your reason(s) for wanting to serve with this group <br />NOTE: Your response to any of the above inquiries may be continued on the back of this form. <br />Please attach any addition material you may want the Mayor and 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 <br />employment without regard of race, creed, color, sex, age, national origin or handicap. <br />