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.91 <br />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: CU Jt<� �C J�LJL l r�tt��i l'- 1)cx",c��J� <br />Full Name (Please Print): �r,-V"v\C­ <br />Work <br />Phone: C—m _� ` I V, (o -5 BTU Work/Cell Phone: <br />Address: 9'3� ? C) �_ Cz\'c(a '6 c_ k l <br />Years at this address: _/_// Years you have lived in Mounds View: 4I3 <br />E-mail Address: ���) t��i=� C <br />Experience and Qualifications <br />Skills and Interests: vLL)���`c� ����YS�c��� r�c�.�.-\-s`\c�� U�� c9C <br />(� � �-(: c - o ✓\` (- vAO (j J) v <br />Employment, Occupation or Other Relevant Experience: <br />`.1 fl C -C) V k i L) c�JE <br />��--�C C 'C �n��c' \ � � �.<< 5'� � S=-�cC�-� ✓-1i5�� v..Z�;� 1'`�-,l����� c�v� C�1 �� C� t� <br />k'cO �'►�)�c�tSll: < Ei L `c?tV`cJJ •cr"fc�r �� I'S'l 1S�fUGCc2"�.J/� (��•'S`�vrRJ{ . <br />Memberships, Accomplishments or Other Qualifications:' h C_ \,.)b <br />Amy j�pC) <br />t V_ <br />1 /VVA- A44 <br />Please state your reason for wanting to serve with this group: <br />,.,3,-L`c�1!\. ,{� F W C� (' `\`�p.� �; "�1.�?-� �J•L��- �(rIl�LIS'`,r�.S:S �C���'c�•�\�/C� <br />Signature: Date: / t.� <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 />facilities and employment without regard for race, ethnicity, sex, age or physical abilities. <br />