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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: CNV I R 01\/N1 ENTf-L QUA-L-17)4 7-4-5K FOR C E <br /> Second Choice (if any): <br /> Full Name (print or type): LES. -T R O TTA <br /> Phone: Home: 7 g 3 - g g I Work or Other: 7 3 - 3 ) DD <br /> Address: 2 2 78 d) S DR 1 v� <br /> Years at this Address: <br /> Years You Have lived in Mounds View: <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER: <br /> Skills and Interests: 1n/ate, V- - vS e Spec-r`ct i ►`s t S/Ki 1 (ed v? <br /> 5rouv►d �v�a`�e�r rooveolektl"sh-rd i`es and ere vest/(too of �a�rhd--wa'ietr- <br /> c..m vtfa r f a[t`a vl <br /> Employment, Occupation, or Other Experience: <br /> Profe Ss ►`ov►a I eco jo3 (st avid lirfro/o (sT wr` tki (S . G-eol icq. <br /> l JJ <br /> cAriv2.y --For over 2.0yeaiS. Served oh Educed-ear, Couhci/ ih Modr'soi) W/S <br /> Memberships, Accomplishments, or �Other Qualifications:_ -{- f <br /> Forme edt{+or of M i 1�111eSotq �j-I�oclv►d Water /455e'C 1Q I /raL1 a'W /OhCI <br /> - <br /> f- r`wie mewtber. T°�t� tca I �cdvt`sov^ -For Pollu+r'on Com-Fp-a/ i49encJy <br /> tM of ►`r1 c'f sq s cep 7`,`6,`/f` �- �-o ro'lhc�-wgfCv colif r"1.'hatooki i`y NI"'tines° Q. <br /> Please State Your Reason for Wanting to Serve on this Committee: <br /> 'w► ale u6li`c sel�vr �e and have Kai sel((a1t4*S . <br /> se-g` t'c back vogy� �0 6rr` vt to en vl`r-o►vmehtet l u�e/+'T <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: /x e Date <br /> / �C — �2 <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 />