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APPLICATION FOR AI)V15c)RY GROUPS <br />- <br /> S. Group Applied For: <br /> --- — --- -- <br /> _ <br /> 7a{)/) and Ita_ emrnit_ siot_ _ <br /> Second Choice ( if any) : <br /> Full Name (print or type ) : .---, --` 11 j: <br /> • Address : � �7 �J �-�'�I� <br /> 7.7 2 e voixruaaryi_ Dc- . <br /> Year ; Al. This Address : Years You Have Lived In Mounds View: <br /> '1'e]tITPhone —dome: _ —uWork or Other: -- <br /> ------------------ 7 S0 ,����c/� ----- o o t rte, - 370 - - <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills anti In •terests . -- -- <br /> �n \o(_i '-4 1 cx5f-3p --I3 , Clnoe(.no <br /> (1,?-111..pc_i _--. CIANiCi ,bc ci-61v..LiNj ol. 6(1111 1-1'-‘-e__A - ,-; c- ul-(1 <br /> Employment -1�� � ':)1_)--EL- .k ,Ii 5 VC Cir/ fill <br /> cupation ordther- ExpFri. .nce: <br /> ��_�o-{LQ C( P t— (--I(Iz -°- ' ft'v c�.�-c .} 31-0-Ye <br /> i L ' r1 c/5,,( <br /> Ya-h it 71-•Acol- -IZciy) �n--v pf..) • e_0. r rru1t ( 1 <br /> B- c.,-, LkI c11� - � So� ` C - m <br /> 11111 Memberships, Accomplishments Or otheruaiificati n <br /> o s . <br /> Par' Ca 06 om pec/ n fY o I vJ 7 {_CL L')L i ./YI,Vt/ z_(_ Y- <br /> 6--CC{ r J.C���'e) !, �- •d l ,c-c L -Fc ,., eve-,-, 0 a LI <br /> - <br /> I (c.)-L.e.4 ( I ?m l c C[ <br /> -- -h cc5- �, -- � �`l kC c����- .c9'� `tet- ,_,_.1-`—� <br /> Please State Ycuc Reasons For Wanting To Serve On This Committee : <br /> Ka_tte. par`-(CLQ k-t Cd (Al ( -( 1-7 % " c� fc < <br /> I-e C p'rOraflu) n__A- Y q—,y (An. ' �IQ a Ci <br /> ,/11�LL.n �a __c_r_ CA1 C( LrY'._ , 1'D�2/1-1' Q-�L <br /> Your r-�sponsd to any of the above may be continued on the back <br /> and you may attach any other materials which 'you -Want the' Council <br /> to consider. __ 4-10,AhSignature - 12 - - 0 I, Date ) - 2- - <br /> y--/ <br /> The City of Mounds View is committed to the policy that all <br /> persons shall have equal access to its programs, facilities , and <br /> employment without regard to race , creed , color, sex , age , <br /> national origin , or handicap. <br /> S - <br />