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a <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: <br />Full Name (Please Print) <br />VOW m';0- <br />I; ar) ne, F. Lova <br />Work Phone: 1 t L Work/Cell Phone: `� (Pq o �t �l <br />Address: 7 `j (� �l t v> y� vi�iGQ.e Y) R <br />r� v <br />Years at this address: 3tJ Years you have lived in Mounds View: I Kp <br />E-mail Address: <br />Experience and Qualifications <br />Skills and Interests: 9 <br />�vlrlmIc-vet inCiltUen' f ) <br />c LSD �&p b n u. 1� > Ll,� �l ` (��C r wu �l y�,eQ f <br />wYvU <br />Employment, ccupatio r Other Relevant Experience: I CVVL� v�o� <br />9-Y)WV4C_SP. a-)�i Pv'I U <br />Memberships, Accomplishmentsor Other Qualifications: <br />lJ (AI`•O C�U�.r� 19'11�'ri2��t'�-�.e ��L�D.Gi,Ltill�I^� �'Ll'QC�,-.O�>�1.� `I%.c UUIQIO,/i_0 <br />Please state your reason for wanting to serve with this group: O <br />1_6 0A <br />� U <br />Date: % -1 1- e5-)-, - 0 I 1-1. <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 />