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City of Mounds View <br /> • 2401 Highway 10 <br /> Mounds View, MN 55112 <br /> (612) 717-4000 <br /> Application For Advisory Boards and Commissions <br /> Group Applied For: Par k S i` e L e ct-fi/v� �' C <br /> Full Name (Please Print): ANTHO N tf K <br /> Home Phone:( 12) 7YO UG D Work Phone: <br /> Address: S-6 7 / 064 t /1/4-,L y St Ft , Mugu S Uie M i" ,j51 t 2- <br /> Years <br /> Years at this address: q Years you have lived in Mounds View: <br /> Email Address: 7 006 I C ki o fi v L . C `71'Y1 <br /> Qualifications You Want to have the Mayor and City Council Consider: <br /> • Skills and Interests: A r 8 e <br /> .1 0 ry Or)���c�LL UAW �, z -160Y- 11 -e. e 11-1ZsCIL"'N, <br /> CG c,Les e jar' s 1-0 /0 yeffi7r..- 0Lc(s e ALSO Poo*17 GL <br /> e Yee . <br /> Employment, Occupation or Other Experience: <br /> -Fre r— Jcrt.tie() / 2T //Z (� e�+y` 1 N -r'h e i vr-e-y <br /> 6 :'c y.) 5 p , ,✓s S"Ci GoL <br /> Memberships, Accomplishments or Other Other Qualifications: <br /> ifilt7 `1 h '� UC'C +T,� c L�C��'sr✓ce,n L Cc u !jS 4 ,2_.0 wl- <br /> V �vt <br /> (�{ F (71 S i� ,L r e/ thin. e-P'1",C v.., G t-c <br /> vtJer' bey- P—PslCt - --) LCS ; in <br /> Please state your reason for wanting to serve with this group: <br /> L he 40c -'Sh ey / / N f3 L L <br /> c C di r A-s for- rJ -i<:-1` (A)e_ coc, cd (.t I`, C-, ?ed <br /> L v+ Gvt U yc. ,r.. , e I aye o S Cm L`>7 e is iv/.f S <br /> Pic n-c�e . <br /> Signature: � �' � &LkDate: 2- 2 �+/� <br /> [Your response to any of the above inquiries may be continued on the back of this form and you <br /> • may attach any other material that you would want the Mayor and Council to consider] <br /> The City of Mounds View is committed to the policy that all persons shall have access to its programs,facilities and <br /> employment without regard for race,creed,color,sex,age national origin or handicap. <br /> U r R <br />