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— <br /> ..a.s ur SLY 10001/001 <br /> ,/ CITY OF MOUNDS VIEW <br /> jj 2401 HIGHWAY 10 <br /> L1� MOUNDS VIEW,MN 55112 <br /> OheA612-717.4000 • <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For. <br /> DI • <br /> rhic -2)6/ 1" 007710. <br /> Seed Choice(ifany): <br /> Full Name(print or type): <br /> I IG/A- t <br /> Home Phone: Work or Other: <br /> 7g3- 7-6‘4, �Z/- 7%5-8 <br /> d4,4 d#We' 00444,1 ,izezezilfs U„,,€) <br /> Address: <br /> Years at this adds: <br /> Years you have lived in Mounds Vi <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER S <br /> Skills and Interests: iea,1 ..1/60i/'; S�L'v,�L �4of'.�.vs�^� G[,.5✓i✓l! �i <br /> 4o,E3l r =ex-OA/47 f /1014 cP1A4eAbes aor ) / Vi e.;•ht-llf <br /> PZIA41/;14 "e `)*Z7- .-Rtfoi:ce_t€(;A.7/-eaot6 Atrvairf,Z.46, ilSe,,A,7r"s7le <br /> Employment,Occupation.or Other Exp <br /> sem' i �� c3 - '4e a ry,M ,✓g ft <br /> Accomph or Otho Qu itch nc: Lfe cs�.�J >°G�.�/ — "I' <br /> 1444, 4 avG,� .Q7f� �� ' .�iE� ,G <br /> 4.4,;/ .�.� .:I4,d4 4 4, 4 ve. 4.J ,.✓ /k sc'- 1 <br /> Please state your masa for wanting to save ca this=mine= �,¢,,e4474. 74, C.44ee. <br /> Aitoa'Fd.• 4.:‘,71t-e c <br /> Yourresponse to any of the above inquires may be continued on the back and you may attach any other <br /> you want the City . , consider. <br /> Sim: / sem z J • <br /> The Cary ofMounds View is committed to the policy that all persons shall have access to its programs, <br /> facilities. and employment without regard to race cree4 color,sez age,national orgin, or handicap. <br />