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10/20/2020 Revize Onllne Farms <br />What is your reason for wanting to service on this Commission/Committee <br />I am very grateful for the excellent quality of life Mounds View has provide illy family I hope to give something back by using my experience <br />as a commissioner and my professional experience to serve as an engaged, informed, and committed member of the Planning Commission <br />Please attach additional information if desired: <br />Choose File No file chosen <br />optional <br />PRIVACY NOTICE: The information provided by you on this application will be used to determine your suitability for appointment to an <br />advisory commission. Participation as an advisory commission member is strictly voluntary and you are not required by law to provide this <br />information. However, should you not furnish this information the City may have difficulty determining your suitability for appointment, <br />contacting you regarding your information, and if selected, notifying you of your duties on the advisory commission. Under Minnesota <br />State Statute 13.601, subd.3, the following information is considered public information before appointment: name, city of residence, <br />education and training, employment history, volunteer work, awards and honors, prior government service, veteran status. Once an <br />individual is appointed, the following additional items of data are considered public: residential address, telephone number, email address. I <br />have read and understand the Tennessean Warning and certify that the statements in this application are true and correct to the best of my <br />knowledge: <br />Applicant Signature <br />Farmer <br />Date <br />10/27/2020 <br />Format: MM/DD/YYYY <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 <br />race, ethnicity, gender, age or physical abilities. <br />https://moundsviewmn.da.revize.com/reports/787l3 2/2 <br />