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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: 4,ecei <br /> «�1 <br /> 5z/4„,e.". ._ <br /> Second Choice(if any): <br /> Full Name(print or type): <br /> 41-74-h: e ;P 41(Chniel" <br /> H me Phone: Work or Other. <br /> �v/Z ?al/ YZ 03 /Z 7/7 VC' 7S <br /> Address: <br /> 5287 Cd9ecoodal. Dr S5 /I2 <br /> Years at this address: 7 2 e a e 5 <br /> Years you have lived in Mounds View: <br /> 2 czear .5 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: <br /> Cromer ` <br /> a 5 we I/ 4C 5 -cor P-ed • "s <br /> Employment, Occupation,or Other Experience: �- <br /> /YLO uKd 5 v,`c�J <br /> e/4 g :70 /504/2, <br /> �o I. <br /> �' Q h1�N 4551 s7 /'Y1 e4 afke .�.. <br /> Memberships,Accomplishments,or Other Qualifications: <br /> �n -f-ere5red ,'�t ener,t / S.-4e -defy ednee1" <br /> 6 r ILL Ge/h 0 l,€ 1'`t e S fr e e -fs c - <br /> Please state your reason for wanting to serve on this committee: /)/ 5 o 71-0 L er <br /> g�� 40-F The f�' Dl/G — f7' <br /> L1-41a'e/-5 <br /> Your response to any of the above inquires may be continued on the back and you may attach any other <br /> material which yo ant the City Council to consider. <br /> Signature: 5/ Date: 9 Z s- go <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 />