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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 /> GroupApplied for: C,vm A55/o n)
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<br /> Second Choice (if any): 214/jl/c,- , 4.&•
<br /> Full Name (print or type): 2/Z4,•/4N 2 ,oRRA Jill.
<br /> i Phone: Home: 7 5-3- c 3--fr5— Work or Other: ,3 y3 -..?(/.3 i
<br /> Address: - -
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<br /> Years at this Address: 7/1?0 •
<br /> Years You Have lived in Mounds View: 7 moo•
<br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER:
<br /> Skills and Interests: /vvkcZ' i 12 .Z.f, 'ZG /o rt /247-4'
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<br /> Employment, Occupation, or they Experience:
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<br /> Memberships, Accomplishments, or Other Qualifications: X ee'. '// / /.rtes
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<br /> Please State Your Reason for Wanting to Serve on this Committee:
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<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: , -�,� �v Date / —9
<br /> The City of Mounds View is comrhitted 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.
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