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MOS IND VIEW <br />2401 Mounds View Boulevard " Mounds View MN 55112-1499 <br />(763) 717-4000 * Fax (763) 717-4019 <br />info@_nioundsviewmn.org I www.moundsvigVDn.org <br />�D L <br />To be completed by Mounds Vie <br />Date Application Received: it tA� 1_ <br />® NEW APPLICATION (never served) <br />❑ RENEWAL APPLICATION <br />❑ APPROVED Date <br />Term Expires: <br />APPLICATION FOR ADVISORY BOARD/COMMITTEE/COMMISSION <br />Applicant <br />Name:Lisa Marquis _ <br />Address:5206 Rainbow Lane <br />Phone #1: 763-350-6854 <br />City: Mounds View <br />State: MN <br />Zlp'55112 <br />Phone #2: <br />v <br />Years at this address :22 <br />Years you have lived in Mounds View: 35+ <br />Email:lisa@premiermaterials.com <br />Applying.. please <br />0 Economic Development Commission ❑ Planning Commission (Meets the 1" and 3rd <br />(Meets 3rd Friday of each month at 7:30 a.m.) Wednesday of each months at 7:00 p.m.) <br />❑ Parks, Recreation & Forestry Commission ❑ Police Advisory Board <br />"as <br />(Meets the 4t" Thursday of each month at 6:00 p.m.) (meets on an needed" basis) <br />❑ Comprehensive Plan Taskforce ❑ Other <br />'ExperienceQualifications <br />Skills and Interests: - <br />Lisa Marquis <br />See Attached See Attached° r Pride <br />ar <br />� <br />office: 763-78S-1411 <br />direct: 763-219,8016 <br />Employment, Occupation or Other Relevant Experience: - cell: 63-350.6854 <br />tisaCpremiermaterials.cpm <br />See Attached See Attached <br />�- PREMIER MATERIALS <br />Memberships, Accomplishments or Other Qualifications: _ <br />_ <br />See Attached See Attached <br />What is yqur main reason for wanting to serve on this Commission/Committee; _ <br />See Attached See Attached <br />TENNESSEN WARNING; The information provided by you on this application will be used to determine your suitability for appointment to an advisory <br />commission. Participation as an advisory commission member is strictly voluntary and you are not required by law to provide this information. However, <br />should you not furnish this information the City may have difficulty determining your suitability for appointment, contacting you regarding your information, <br />and if selected, notifying your of your duties on the advisory commission. Under Minnesota State Statute 13.601, subd.3, the following information is <br />considered public information before appointment: name, city of residence, education and training, employment history, volunteer work, awards and honors, <br />prior government service, veteran status. Once an individual is appointed, the following additional items of data are considered public: residential address. <br />telephone number, email address. I have read and understand the Tennessean Warning and certify that the statements in this application are true and <br />correct to the best of my knowledge: <br />i NWXApplicant Signature: <br />Date: 112-//,? <br />Your response to any of the above 7nquiri4 ma be continued on the back of this form and you may attach other information <br />that you would like the City Council to const <br />The City of Mounds View is committed to the policy that all persons shall have access to its programs, facilities and employment without regard for race, <br />ethnicity, gender, age or physical abilities. <br />7 <br />