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ti.ay.10. 2015_11:28AM -cel Eier,v EcIra Consf,tic-inn <br />MOUND VIEW <br />City of Mounds View <br />2401 County Highway 10 <br />Mounds View, MN 56112 <br />763-717-4000 <br />1a.682t 1 <br />APPlication for Advisory Commissions and Committees <br />Group(s) applied for: <br />dull Name (Please Print): _ ,�... <br />Work phone: 411 � �6 ? z `�'� <br />Address: v,5- t j LA <br />Years at this address: 0 <br />E-mail Address: <br />no <br />Phone: <br />Years you have lived in Mounds View: <br />5' _ <br />Ex erience and Qualifications <br />Skills and interests: <br />7 <br />t <br />Employment, Occupation or Other 1Relevant Experience: <br />'A004 Ql Ffi to, o'? +9� 1�t�+ tk r+�[ eo-. C'4 Atli C% �. J +g li re u fivt <br />Crecvs <br />Memberships, Accomplishments or Other Qualifications: <br />)r_ Y114 ?y(15 6&0.'4M eM6.' <br />vlz5 in P, r-. <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 V &w is committed to the policy that all perso»s shaff have access to Its programa, <br />facilities and employment without mgard for rsce, efhniciiy, sex, age or physical abilities. <br />