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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 /> (vii/tufuizt-&. <br /> Second Choice(if any): 1 <br /> Full Name(print or type): <br /> ar 1007, A / a /am <br /> Home Plcne: Work or Other: <br /> 0/2) 7 (a /(02 Z ((//) ) )g %- ??-60 <br /> Address: n)atdri <br /> Rg(a l _657/L -f/jv <br /> Years at this address: J <br /> S <br /> Years you have lived in Mounds View: <br /> 3 Yerut_s <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests: ,,y <br /> .: .4_ t'/ fr- <br /> Employment,Occupation,or Other Experience: <br /> Memberships,Accomplishments,or Other Qualifications: <br /> ,)(Lq re IP <br /> r ""A'�S� <br /> Please state your reason for wanting to serve on this committee: <br /> ,� �i IjLC fLL�% <br /> e <br /> 5u� J /99'7 ft i c ,. ' /�� <br /> itr m t-:.,L tA. w�c/< 1 '2 'r' /Ovalam . '1`1�..�A � . V1,44 r ' cs <br /> Your response to any of the above inquires may be continued on the back and you / �'G��� <br /> material which you want the City Council to consider. 'attach�Y other <br /> -76 <br /> Signature: ✓/ I 'A / ,'r �``` Daze: 9;1 <br /> The City ofMounds Pew is committed to the policy that all persons shall have access to its programs, <br /> facilities, and employment without regard to race, creera color, sex age, national ora n, or handicap. <br />