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CITY OF MOUNDS VIEW <br /> 2401 HIGHWAY 10 <br /> MOUNDS VIEW, MN 55112 <br /> 612-7174000 <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For: <br /> Farb<�- �. . Cori �S. <br /> Second Choice(if any): <br /> Full Name(print or type): ,71-7 <br /> Home Phone: Work or Other: <br /> 1Z - 7r6 —S'c��• <br /> Address: <br /> 521 a' -FL-re P <br /> Years at this address: <br /> Years you have lived in Mounds View: <br /> QUALIFICATIONS YOU WANT TO HAVE Ii € COUNCIL CONSIDER <br /> Skills and Interests: <br /> ca /1,04)4, c7- / l t i S-��yI l//l4 %7'a,vtc/ o--r,4i4 <br /> S '1''0 ),Le_, <br /> 1,e Ivo�' Alt4Cc7 -Palky-/fr; <br /> Employment, Occupation, or Other Experience: <br /> bcz y Cee <br /> .dt of i'v► I a GI e h 'f � Ce �1 i:�1jf <br /> Memberships, Accomplishments, or Other Qualifications <br /> &t n�2 S I J-2. �1.2 - ` 0 y 1 q �. " 1 9 ' <br /> C o..ad-C/) 13 a 5'e d(ill et r J <br /> C0/7141 u n i C Cite, •`tri c 4-z '-.t v t4 C-e, <br /> Please state your reason for wanting to serve on this committee: <br /> 62�I�L�-t_ <br /> �ti�, �' iM _� L � CL <br /> ( ,1-0/2.1; 644 CLO sfa ' - - e 1 <br /> Your response to any of the above inquires may be continued on the back and you may attach an ' <br /> other material which you want the City Council to consider. y <br /> Signature: I ,,, -e ,. <br /> 4011.64," Date: jl / yr <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 to race, creed, color, sex, age, national orgin, or handicap. <br />