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City of Mounds View <br />2401 County Highway 10 <br />Mounds View, MN 55112 <br />763-717-4000 <br />Application for Advisory Commissions and Committees <br />Group(s) applied for: _Economic Development Commission_______________________________ <br />Full Name (Please Print): Dennis Victor Farmer________________________________________ <br />Work Phone: 651 602 1552_________________ Work/Cell Phone: 612 867 8293__________ <br />Address: 5117 Irondale Road Mounds View MN 55112 ______________________________ <br />Years at this address: __12________ Years you have lived in Mounds View: ____12___ <br />E-mail Address: dennis.farmer@gmail.com___________________________________________ <br />Experience and Qualifications <br />Skills and Interests: <br /> Please see attached sheet. <br />Employment, Occupation or Other Relevant Experience: <br />Memberships, Accomplishments or Other Qualifications: <br />Please state your reason for wanting to serve with this group: <br />Signature: _________________________________ Date: _______________________ <br />(Your response to any of the above inquiries may be continued on the back of this form and you <br />may attach other information that you would like the City Council to consider.) <br />The City of Mounds View is committed to the policy that all persons shall have access to its programs, <br />facilities and employment without regard for race, ethnicity, sex, age or physical abilities. <br /> Please see attached sheet. <br /> Please see attached sheet. <br /> Please see attached sheet.