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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): <br />Work Phone:- 6 - L qU- �Q g (v Work/Cell Phone: �3 <br />(P <br />Address: U 3 S 5 � �,eGCsat4l 06W V r' V_e- <br />Years at this address: q. <br />Email Address: <br />Years you have lived in Mounds View: Y s— <br />Experience and Qualifications <br />Skills and Interests: <br />tNN4%er �w (iJ <br />Y.Ro-eau- a,J,L�S '�eqD rewv� <br />Employment, Occupation or Other Relevant Experience: <br />a 7 Pftil�I�cauf+�,Ul�vtm(,u��ly,a`-�Lco,n-o,v�.i� v�V.P��v,-cZu.9-, f'I��Yti-�rN��l- <br />Memberships,'Accomplishments or Other Qualifications: <br />® i gz441.b-ei✓ — lai vtn" 6 faL_ /k s o r a h7� r�, tfi v✓eirvch 0, & W vi ,4 , &'j -6v S <br />ty'i�% CICA &,�va �eQ F�PE?oti✓, (�w vws u�lifl�l 120/3 tors <br />l-F"6r 5-„�,,r(awl V ,A1Qj 20 3 aDIS <br />Please stat4our reason for wain to serve with this group: <br />/'ln �Pwua ^v'e�i�e � (/;~ r� v� <br />6"n LL�tf 1 A cLL0.fre <br />P��, /I/ �� ��e te e, <br />Signature: / 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 shall have access to its programs, <br />facilities and employment without regard for race, ethnicity, sex, age or physical abilities. <br />