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Board/Commission Applif <br />Full Name (Please print): <br />City of Mounds View <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />Phone 763-717-4000 Fax 763-717-4019 <br />www.ei.mounds-view.mn.us <br />Home Phone: 7� `7 7z'3 G ",>, {7 Work Phone: <br />Cell Phone: Years lived in Mounds View: f� yam' r1 <br />Address: ?.A u+ <br />Email address: <br />Qualifications you want to have the Mayor and City Council Consider: <br />Skills and Interests:_/jcCvt <br />l <br />Employment, Occupation or other Experience: ;11<<sr`r?r� /)3(17:-C= C, / <br />i+% o6� <br />/l/- -51- <br />Memberships, Accomplishments or Other Qualifications: <br />Please state your reason for wanting to serve <br />with this group: _� r' , , c i� o k r�,' I <br />er/7rt-S `f' 12ei'/q '-, .7�,./-_..EY /W."11.E!✓S tliCu).. +Zrltf .}CI <br />v <br />' v <br />i� lj <br />Signature: cLe>.,.4� , F �_--`r' ®ate: )/<<V • /17 e 61// <br />(Your response to any of the above inquiries may be continued on the back of this form and you may attach any <br />other material that you would want the Mayor and City 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 employment <br />without regard for race, creed, color, sex, age, national origin or handicap, <br />