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• <br /> APPLICATION FOR ADVISORY GROUPS <br /> 4110 OR COMMITTEES <br /> Name of Group or Committee Applying For: <br /> Second Choice (If Any): <br /> Full Name (First, Middle, Last): 17115 . �I <br /> Address:. ?4'c t o f (w 01) 4 Da: <br /> Years At This Address: Years You Have Lived In Mounds View: 2_0 <br /> Telephone Number Home: -756_447.7i Work or Other: 7 A <br /> QUALIFICATIONS YOU WANT THE CITY COUNCIL TO CONSIDER <br /> Skills and Interests: <br /> rC NSZ'Ve rc`.1),Ft i Gtc `N sNtSx .44ANtF <br /> • Employment, Occupation, or Other Experience: <br /> Memberships,Accomplishments, or Other Qualifications: <br /> 12O� r ort.[ls /rf Sac.;AF-PS mar•.\art. -�C.�Mvc_ 13F KM/A- S fE+,• -c4- d F3 C ►nn. <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> cor-l'rt�bv�a� wter" vJD/t4-o i4,"(21tflvt;-- 4-ke si e c', <br /> 1- PA-s q'YQ7 arick , <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 �. -,,,••�.Y " 2Q Date 7/2„.7/9 <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its OP <br /> programs, facilities, and employment without regard to race, creed, color, sex, ace, national <br /> origin, or handicap. <br />