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CITY OF MOUNDS VIEW <br /> 2401 HIGHWAY 10 <br /> MOUNDS VIEW, MN 55112 <br /> (612) 784-3055 <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied for: <br /> Second Choice (if any): <br /> Full Name (print or type): (2.10ek, toyl . A <br /> Phone: _ Home: /10-1 — Work or Other: <br /> Address: ct \ \ f i€CL avv Qv- Dy- <br /> Years <br /> yYears at this Address: l <br /> Years You Have lived in Mounds View: <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER: <br /> Skills and Interests: 0t4t \th s COVv. e / . -)OnI if t,(4 <br /> Employment, Occupation, or Other Experience: <br /> \)01%)•-k1 LAYLk 4t \-)0I. ct,T f-e <br /> Memberships, Accomplishments, or Other Qualifications: <br /> J <br /> t <br /> Please State Your Reason for Wanting to Serve on this Committee: <br /> llrr,00k_ ice J 1 J t r,L tovvvww✓vt .S <br /> -tb tv-matv‘witAkiti �. S <br /> Your response to any of the above inquiries may be continued on the back and you <br /> may attach any other material which you want the City Council to consider. <br /> Signature: 6\Nr,5.,_, kms` Date 3�-sL <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its programs, <br /> facilities, and employment without regard to race, creed, color, sex, age, national origin, or handicap. <br />