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APPLICATION FOR ADVISORY GROUPS <br /> • Group Appl1ed Far. <br /> Second Choice (if any): <br /> PLApN iN6 <br /> Full Name (print or type): (-) <br /> � o 1q N <br /> Address: <br /> c;0.6_ <br /> 0 5 6k° ci Rd, <br /> Years at This Address: Years You Have Lived in Mounds View: <br /> 9 <br /> Telephone: <br /> Home: Work or Other: <br /> 756- 6679 3i - 6ss CR) <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: ' <br /> &As/Nass a w,vFn <br /> / .C3 vi t�,¢ / #Omc'pGv uF,� <br /> Employment, Occupation or Other Experience: <br /> GI N6.2 p � 1?l�d //OA/STA/4770N00, <br /> /4e/no oh 11x/3 Liampisvy <br /> emberships, A mplishments or Other Qualification: <br /> Imo vAly y/F ltd/c�F I�RFI p <br /> eba,P7-6� eamm,ss,i.v E,t.�tAL Xnip WL� /� <br /> LA�oIs�A Iv .9 vsssfss,Please State your Reasons Far Wanting Ta Serve On This Committee: <br /> .3',vnc,e6s r /,v � <br /> E _z-m ,vaveemete7- o/ d v,e ,-;,cite <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 /> •Sinarure % <br /> r `44' Date 7-1'9? <br /> The City of Mounds View is committed to the police that all persons shall <br /> access to its programs, facilities, and employment without regard to racs creed, color, <br /> equal <br /> sex, age, national origin, or handicap. <br />