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CITY OF MOUNDS VIEW <br /> 2401 HIGHWAY 10 <br /> MOUNDS VIEW,MN 55112 <br /> 612-717-4000 <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For. <br /> 5 eth CieWkWalat <br /> Second Choice(if any): <br /> Full Name(print or type): <br /> Home Phone: Work or Other: <br /> d)54-11-10 <br /> Address: <br /> g� g� Spr i Lk. . -Rd . <br /> Years at this address: <br /> Years you have lived in Mo View: <br /> 4-S e— <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> 474 <br /> Skills and Interests: 44.0 . <br /> j( 4.G i l Sr 5k e5, Coot d 7t t <br /> C�eC45 , <br /> 06 4-K- c ltbk. so1.�a o <br /> j'l r o ba4o s ul e4t.Y whP.A. lre4t <br /> Employment, Occupation,or Other Experience: <br /> Memberships,Accomplishments,or Other Qualifications: <br /> Please state your reason for wanting to serve on this committee: <br /> Ee ca u,45 - t -1(ed 4tu.. Ca .,uu;-lEec,-fa 6 L $ vwt 4 . <br /> Your response to any of the above inquires may be continued on the back and you may attach any other <br /> material which you want the City Council to consider. <br /> Signature: Akin jkttti,4 Date: / b <br /> The City ofMounds View is committed to the policy that all persons shall have access to its programs, <br /> facilities, and employment without regard to race, creed, color, sex, age, national orgin, or handicap. <br />