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OCT-29-2009 THU 01:58 PM AMERIPRISE FAX NO, 612 671 8947 P. 01 <br /> ft11 I <br /> MQ TNi s Virw <br /> i 1 City of Mounds View <br /> 2401 County Highway 10 <br /> Mounds View, MN 55112 <br /> 763-717-4000 <br /> ;I <br /> }� ApplicatiCommissions and Committees' <br /> (; n for Advisory <br /> Group(s) applied for: Et-000 M t C.- / t <br /> PE O FMrity` L oM M t%s I d o <br /> • <br /> • <br /> Full Name(Please Print): ANSCA,Svi g• 40141 SOMI _ <br /> 1. <br /> Work Phone: b14 I`I i$- 7101 Z Work/Cell Phone: 7 b 3- 4 143- 1 I'OO <br /> Address: 2 q 3 7; L-A-POG"C OR. V Aou lid s V l 'r4 A4 N S`,a 112 <br /> • <br /> Years at this address:I '1� Years •you have lived in Mounds View: _i <br /> E-mail Address: AI�U HA S 4144P4 It*1 L L. GO I4A <br /> : <br /> j Experience and Qualifications <br /> • Skills and Interests: <br /> I ate Col -L. F....r/ e ecv,vo m [ a Sr ,1~ O�l <br /> GVe411 C 00:1,64'a'"G.rr . <br /> Employment, Occupat on or Other Relevant Experience: <br /> WA'oz.X F "fenir.rt i Pezi SE f ,l✓st,ws fr4L.- A A cduupLi ANGE <br /> Pliv ro„NK %wrr tbi.4 feJvCPr*ti,►fieri5 . •F Vtdt)S14 <br /> I / W u g-PFO Pt S A t 0 A pi c I I'k'-- riztvlsorz. . <br /> yi Memberships, Accom lishments or Other Qualifications: <br /> 2 NA/KO S- O,�'O4 Rice ,A( F`i &t twJA1 AL-r.e.044 Ai(4 A, 611157-k VU S <br /> Ps-061—PA,' C.o�.pr,6cj F- 7 ►�'1 A Seg 1-/4...01V50,9 7�trrvi•Iiii i ri 4 W 1" 14 <br /> M 5E04 ., `'7, f r•c a 01 GE, 4 s etc% C's 24, <br /> Please state your reason for wanting to serve with this group: <br /> 1,✓t)V`b G ✓ I *EA-VE imAl tiNALRA.441 Ili ItirwJ4 H Wfi/S hiUi <br /> E. y r v6eV 0 r)tic fir,ON#'rL - ek,sr v,✓D 1 (111201404S,O 1*V- Eje ff-(rsJL <br /> 1: M �4.r.4. Ars N'r 5T /4r reit.!esvn I e.-s, / f,1C -f 17(1 t'to ip <br /> iSignature: Date: I a Zi zeao Glieek ? $e <br /> . <br /> (Your response to any of the above inquiries may be continued on the back of this form and you 4 7" <br /> may attach other informs ion that you would like the City Council to consider.) f`,1*- <br /> • faci'k'1 The City of Mounds Vow is committed to the policy that all persons shall have access to its programs. <br /> lities and employment without regard for race,ethnicity,sex,age or physical abilities. <br /> it <br /> 3, <br />