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CITY OF MOUNDS VIEW 2401 HIGHWAY 10 MOUNDS VIEW, MN 55112 (612) 784-330�055 / EE APPLICATION FOR Group Applied for: b ye V 1 RD U11M,e.Vvl u\ t1 Cl��t� TiSC v ce, (0)/4 0,1 ;7/46 Second Choice (if any): Full Name (print or type): Tvv o 4-V l iil Phone: Home: 3-83 - 00 8 5 Work or Other: Address: 1245 G ro L efl S+-rQe-+ •# 2. Mo-V VteuJ , IAN. SS ) r Z Years at this Address: 3 Years You Have lived in Mounds View: 3 QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER: Skills and Interests: I v vi e d c/ '\\)e,l`j C`e Re.,w S pa pef s , C 1 1 s etc P,or ZD y t,?, v iy1 -F-ke 16-9i. ouvt y + 1Avv �o CCs p recd1�\ tQs , -11\e Pav s kbl f�-`mss ( o evispaces \otkc.e.s VaAi(A c, CY'oo1/2Co u v4e 1 S k_ - Employment, Occupation, or Other Experience: Fo yr vett v S� e wl f k o�J 4l e kL QkS a Oooh +o -C�ooc� ccLv iasse�' , 'CJVI d dui v�r� (tA-O e v"-IL vt,� (1.,kDo kfr vA v t Qan vVtc;v,--a\ Memberships, Accomplishments, or Other Qualifications; VlA i vi vt e o+u Po ' `c rpp C P1$G) cKka, soca (_ T3oard �ceurbe✓` ova (rovese(,C tw STree boar,A, „>-_ C '`i F wl\cs-issgp� F?vev Rfvtvc I CLeaIk-u p \cl5Z Lo lv Ote 11S 4.&.-fo'0, o11 Uctf�� enaneve 5 VeC• 4ilei ada ve- I Please State Your Reason forWanting to Serve on this Committee: Gds S y,e,� blas 00 act ac,Lr ire use( of- ?R v ies 5,0a ce s, 4- i'o f 6 a , O OUB (101€-±; IAA ds i(4i G((v��rdsv) e� ci I , e Go(t course, . .! pfo� s� teG eic¢rve`y � firotiiveverions /1 $ /e. Your response to any of the above inquiries may be continued on the back and you may attach any other ..ate ial which you want the City Council to consider. � / y3 Signature: r1,1i/ , iii Date l /S/ 9'3 The City of Moun•- 'iew is committed to the policy that all persons shall have equal access to its programs, facilities, and emp oyment without regard to race, creed, color, sex, age, national origin, or handicap.