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t � <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For: <br /> CCVYI Drn t G t,cf•-- e_Dm rYt tai b <br /> Second Choice (if any): <br /> 161.Y1 n'1 Yl CD rnyyl i 1Srl <br /> Full Name (print or type): <br /> L1b 424/)(41 `12a,>4 Marty <br /> Address: <br /> LoU:Q, t fire- ry\D u. 6 -037‘ <br /> Years at This Address: Years You Have Lived in Mounds View <br /> V.Q. 7 I/ <br /> Telephone: Home: Work or Other: <br /> 7$b 7ag-45 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: <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 /> 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 /> Signature _ , . ►A it , • 4,A �-ii/k. � <br /> 41Date _.729Z <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 />