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APPLICATION FOR ADVISORY GROUPS <br /> • Group Applied For. <br /> �, D . c. <br /> Second Choice (if any): . <br /> PLA> ,N , N6 <br /> Full Name (print or type): <br /> kicAhEd b. OITIAN <br /> Address: <br /> dao s Rd v6LANd Rd. <br /> Years at This Address: Years You Have Lived in Mounds View: Q <br /> l <br /> Telephone: Home: Work or Other: <br /> 7?6- 6679 31- 65-5-6, Cp. ) <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: gaslivess eg. / vi, <br /> • <br /> Employment, Occupatiorr or Other Experience: <br /> 4 RDO //O./STA/MNTu Cp, <br /> vN62 0FQeiracteli,v9 LampA7vy <br /> emberships, A mplishments or Other Qualifications: <br /> ' movArv3- y,Fw U/ic�F l�RFA 0 <br /> ekA,ex,e eamm,Js,iv NpWL,td9<- vssimess e'aArs7ri.seriN <br /> LI9A' /seiv/u 5 /', aAiee r O ' ,C S, , <br /> Please State your Reasons For Wanting To Serve On This Committee: , <br /> J,4,1?'"es r /A/ 7 E rAvmoverflew- d, d v,e ",de <br /> Your response to any of the above may be continued on the back and you may <br /> attach any other materials which you want the Council to consider. <br /> Ah Signature '/2iL0 <br /> Date 7 9? <br /> The City of Mounds View is committed to the police that all persons shall have equal <br /> access to its programs, facilities, and employment without regard to race, creed, color, <br /> sex, age, national origin, or handicap. <br />