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41, APPLICATION FOR ADVISORY GROUPS <br /> OR COMMITTEES <br /> Name of Group or Committee Applying For: E:cmu, r ar/ <br /> Second Choice (If Any): <br /> Full Name (First, Middle, Last): 111,t, D fe r ri <br /> Address: 94O ' g.„o 1 /wood De(1 <br /> Years At This Address: ZO Years You Have Lived In Mounds View: 7 0 <br /> Telephone Number Home: b_g,"7-;I Work or Other: 7 A Z <br /> QUALIFICATIONS YOU WANT THE CITY COUniCIL TO CONSIDER <br /> Skills and Interests: <br /> k y Y,N as <br /> • Employment, Occupation, or Other Experience: <br /> By r J v 5;;-S G Arr+K..%w+u Lget- -Ft rt s'-r' s p&+ _ <br /> Memberships,Accomplishments, or Other Qualifications:/ ` T <br /> I?oYtnzT M ort or p-rSae-;a�S rr+�v., bcy 1Ct'`A�t t r iv A- 51'fli'e►,.�+►f—S+ic ;o3 C."m,vk. <br /> Please State Your Reasons For Wanting To ServeOnThis Committee: <br /> Gor--17ti�ovkir Mr1+r�f7E"n- vJDft�Gi to iM '.tov5-- -1-ke 13vsiKt:S'S cIim4* <br /> ..i 4-14 its w I r , c i --L� 41VA Mr, <br /> Your response to any of the above may be continued on the back, and you may attach any <br /> other materials which you want the City Council to consider. <br /> Signature �.1C�-Y,��.-� , �, ,Q Date —7/-+_.-!iq-? <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its <br /> • programs, facilities, and employment without regard to race, creed, color, sex, age, national <br /> origin, or handicap. <br />