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• <br /> City of Mounds View <br /> 2401 Highway 10 <br /> Mounds View, MN 55112 <br /> Phone 763-717-4000 Fax 763-717-4019 <br /> www.ci.mounds-view.mn.us <br /> rs rs <br /> Application for Advisory Boards and Commissions <br /> Board/Commission Applied for: �C o 1�3;� o- c. j).:. "2 t� (J�n a1.3 ,r+�r�,:ss.4„J <br /> Full Name (Please print): i ,3s r.s -z\<5\e <br /> Home Phone: (c.S I - 7 $(c - s a c1 Work Phone: S I Lam► 0 7 811 <br /> Cell Phone: 471 •L - 7 7 0 - Years lived in Mounds View: 0 -- i.)i , r <br /> 9 <br /> Address: 7() 4.5 A V&A 07..e. : v-e L ;ti :. 1— IC-es' PIA./ <br /> Email address: M .lye.o... 0`c e LA.)u S•Vz r,.i •- 4 ,,s . r <br /> CJ <br /> Qualifications you want to have the Mayor and City Council Consider: <br /> • Skills and Interests: A %\ S+ a r S . V-113N l:,, q, •i(G. ( 1 . <br /> Employment, Occupation or other Experience: Z.Go o •r Pies; .i- <br /> � <br /> t?.) -M4,0 L�S cfrJ ` e..n.i 1�, -(�n 4,0 . �1 Tc.s. (..cmg,,,t i �c.�.., 112;.6. psi' Bc.ro kk-1• <br /> AVP7R. t3H) r - (a.s..> sr 13c-0 1” 1 ygg -4�t ( t t (3::7ril)k 6MC <br /> ( <br /> • :J t L 1"&i.ic ' PGS f MN <br /> r <br /> Memberships, Accomplishments or Other Qualifications: (c, -I1 V L b C.-i <br /> BA 0n.) c.i 4- c,,1. (h.Nnie.s } c,, - C� ric-- k <br /> % -c I ( c.e., r c O. rtc rS f L.r,.f A Lci / t..5 C <br /> Please state your reason for wanting to serve with this group: � / 5-Q.(v <br /> c J- ,;5 e s S c c,0-1.•A-,--) � � + a 0-t y �,>'c (.,e <br /> 41 : �� 4--0 4-1..) _ <br /> Signature: ( Date: /0)3 4,1 c ? <br /> (Your response t any of they a ove inquiries may be continued on the back of this form and you may attach any <br /> • other material tha you would nt the Mayor and City Council to consider.) <br /> The City of Mounds View is committed to the policy that all persons shall have access to its programs,facilities and employment <br /> without regard for race,creed,color,sex,age,national origin or handicap. <br />