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APPLICATION FOR ADVISORY GROUPS <br /> OR COMMITTEES <br /> Name of Group or Committee Applying For: co,vo cc <br /> Second Choice (If Any): <br /> Full Name (First, Middle, Last): S'i cn1 - <br /> Address: �LCi ( � Q nT� \, 74. <br /> • <br /> Years At This Address: -33 Years You Have Lived In Mounds View: 33 <br /> Telephone Number Home: 7s'f-7-228 Work or Other: „5-7)/— 3o / <br /> QUALIFICATIONS YOU WANT THE CITY COUNCIL TO CONSIDER <br /> Skills and Interests: JI2 7 Pc30P�� P`1671\ic-77 <br /> Employment, Occupation, or Other Experience: <br /> Memberships, Accomplishments, or Other Qualifications: <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> ZvTe(a s i-p t y /11.0 v n.),0S U r cf../ A\ c c..o P i��(r IA) A- <br /> f-k Sc LL.,/ ? Sid /JS ' Le- <br /> Your response to any of the above may be continued on the back, and you may attach any <br /> other materials which you want the City Council to consider. <br /> Signature / Date <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its <br /> programs, facilities, and employment without regard to race, creed, color, sex, age, national <br /> origin, or handicap. <br />