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Oct.25. 2013 2:46PMI Xcel Energy Edina Construction <br />City of Mounds View <br />2401 County Highway •10 <br />Mounds View, MN 55112 <br />760-717-4000 <br />•��lio. 1863'%/?. I' <br />Application for Advimy commissions and Commiffees <br />Groups) applied for: <br />Full Name (Please Pri <br />Wort( Phone: �5�@ o5 -,2j,3 <br />Address: <br />Work/Cell Phone: ✓� ` <br />Years at this address: ( Years you have lived in Mounds View: <br />E-mail Address: � �° r Z- r— t-�"v a-( <br />EExaarlence and C2uallficationo <br />Skills and Interests: <br />Employment, Occupation or Other Relevant Experience: <br />Memberships, Accomplishments or Other Qualifioations: <br />Please state your reason for wan Ing to s,rveey_ywwit�thhh this group: <br />Date: <br />(your re 'f aps��any c�FM; above inquiries may be continued on the back of this form and you <br />play ettac t other information that you would like the City Council to consider) <br />The City of 49ounds View Is eommilled to tha policy (hat all persons •shall have 1WOSS (o its programs, <br />facifitios and employment Without regardforrsce, uth1710113; NO, age orphysical ahili(Am. <br />