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APPLICATION FOR ADVISORY GROUPS _
<br /> Group Applied Far: /
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<br /> Second Choice ( if any 72&-.-.7�f/�1 7
<br /> Full Name (print or type) : 1 ,
<br /> (4)RA 1 e 41 71-):4>V 0-IL
<br /> Add ess : ;
<br /> fiytoiCni i i) 66 t/L / /a Ph v YPs �'J I Yw. //cam
<br /> ye rs t This Address - years You Have Lived In Mounds View:
<br /> L1 if L& = l ei f_S You, /.� `F 4',y 4)i/ ' traj/ —
<br /> Telpp ong Home Wort r Other•
<br /> (l < 1144_4 - �/f,2- V )67L / 17.70.-ind(0 `G /7 30
<br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER
<br /> Skills and Intere is : �' �i�� �" % L- - e
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<br /> Employment, Occ' _ tion..or O er Exoera_'� 4n .. .
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<br /> M erships , Accomol .( ments Or Otne L�Qualifications : .{
<br /> J � etz -ii.% (7 ;k 9) Ii- e ,,, A/4,',Lenz Oet-�—iZ= �L% J
<br /> i / m/ 1/#11_ be Olke i ga�7T7yt Ca/eciri f/KS -
<br /> Please State our, . easons F^r Wanting To Serve On This Committee :
<br /> TO "-J4-"---Cf/i ' (.- _,,,‘„; Ofv- .4:---4),,,Z -L, ,, - -p--,--L_cd--7--, St_el 1/474,--7-2- ,e,_4,,,e,,,c_i__, -
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<br /> your response to any of ti' + above may e continued on the back
<br /> and you may attach any other materials which you want the Council
<br /> to consider.
<br /> S i nature �Z, L-� / cc_c Date g49-C/i1 V
<br /> g � L �
<br /> The City of Mounds View is committed to the policy that all
<br /> persons shall 'nave equal access to its programs, facilities , and -
<br /> emoloyment without regard to race , creed, color, sex, age,
<br /> national origin , or handicap .
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