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City of Mounds View <br />2401 County Highway 10 <br />Mounds View, MN 56112 <br />763-717-4000 <br />Application for Advisory Commissions and Commiffees <br />Group(s) applied for: <br />PARKS <br />Rc-c9M47Ww *" <br />Full blame (Please Print): TC--om VA(z <br />Work Phone; <br />Work/Ceil Phone: '767"q06-7713 <br />Address: 9xey Pce-41-4wr V.trow Drum <br />Years at this address: $016 Years you have lived in Mounds View: 16 <br />E-mailAddress: <br />Exaerlence and Qualifications <br />Skills and Interests: <br />'tgcrt- aEArroW <br />Employment, Occupation or Other Relevant Experience: <br />Ra4i2CAr vrl <br />Memberships, Accomplishments or Other Qualifications: <br />C 61vt PHc=asx1v4F P,1,4,/ ASK f=404tc <br />Please state your reason for wanting to serve with this group: <br />rj-Aji!`Sra UJORK 9TA2TEO <br />signature:t% * 9 Date: ll -22 -/3 <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 shall have access to its programs, <br />racluttes and employment without regard for race, ethnicity, sex, age or physlcai abilities. <br />