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CITY OF MOUNDS VIEW <br /> 240I HIGHWAY 10 <br /> MOUNDS VIEW,MN 55112 1115) <br /> 612-717-4000 <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For. <-•// (( •0 ti <br /> c, <br /> Second Choice(if any): <br /> AYA <br /> Full Name(print or type): <br /> LiaAJ•e1 t'. L'oUtJ A 1, ,J <br /> Home Phone: —7, Work or Other <br /> LG(c2) 1400 !— <br /> Address: ?A/6 jpr'; ,u L.a,AH00.01 NV 6 /f -�fL✓ <br /> Years at this address: <br /> Co /? ye.A-LS <br /> Years you have lived in Mounds View: <br /> QUALIFICATIONS YOU WANT TO HAVE 1HL COUNCIL CONSIDER <br /> Skills and Interests: e iptr-Ac.: ,A,,; meeker a7 fX e Slor/cx(ak . <br /> 9rcu f. Vera int, -P :s -fopi c, . <br /> 1/7 <br /> Employment, Occupation,or Other Experience: <br /> & ( F croup !(oder{br Ztveta./ yescrs (LN c iela.,o r(c Se#fit ) <br /> ?�jcvs dxper;e.c._t, as rti rr. 'eL,uo ev/, rac I v (ti,c e i:..�5, -a:-;:,;ki Kvs`-vil bt -TMP•) <br /> Memberships,Accomplishments,or Other Qualifications: <br /> **Sri SA:Ac,40r9 4,60ue. <br /> Please state your reason for wanting to serve on this committee: <br /> t-4(1.0 1 i(Lf pkr a7 C+{! /� r`c A - f Il c:��11 CiLlcuc7�JLLM�JJ I wou I. `l\, t <br /> L ;l / O <br /> C?3Asl";.uv f, SefU� X� ?fir Qom/num-4/ /ti'1'4rs arm„ y knxxole � ol',rxcsf of <br /> k Ll p -tn ;or;,ug ��r,t rsu,cjr j1' ,•vR 7��Ueed" au 1 <br /> Your response to any of the above inquires may be continued on the back and you may attach any other <br /> material whichyouu want the City Council to consider. <br /> .67 / -7 <br /> Signature:-. A ,� car t 4 (4 , Date: .i/AFX?? <br /> t <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, creer4 color, sex, age, national orgin, or handicap. <br />