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City of Mounds View <br />2401 Highway 10 <br />Mounds View, MST 55112 <br />(763)717-4000 <br />licat on dor Adviso Boards and iota missions <br />I� 1) <br />Group Applied for; �S �rf�.G��ie anJ l[�0`eSLL., <br />Full Naive (please Print): d r � o•�. <br />Home Phone: -945 01;03 . .. Work phone.. -7613- 9-5-2 Z13� <br />Address: Dail r� -- <br />Y=s at this address:, 2— 'Rears you have lived in Mounds 'View: '3 <br />E-mail Address: e Co An ca'� A Lqo <br />I/ <br />�Lualifcatioris You Want to Have the Mayor and City Council Considen <br />Shills and Interests: <br />ryas Ucr '—'1. �$A`G 0 e2Cr12 c7fatln� i 4rw� �tncf S�en� <br />�a✓ f� �}�ft IFN ��h`in 1• /wwo 11 J Lrtci✓ �•1cQ CQauv�ll� a� %Av��! tvdl <br />Employment, Occupation or Other Experience: r+? -y! i �4@. <br />�.'�oi1��{1' ar.,+�.. '�!ib^l dV`�se'�: S'nKa.'�Fe•�.d asS�9 ��gµc1 ��' �• R? +1�Ista <br />0411 <br />Mernberps, ,A•ccomplishthunts or Other qualifications"", <br />: <br />T /1—C A BS /,4 Ake, <br />T Advo sc-Ue-1 A vaP;cu,s 40". <br />Please state your reason for wanting to serve with this group: <br />At a .Aaj, a,S <br />c,`ly eon IJ/e". !'s crP.`4- x+11. <br />�ssds 1nc1 cP� a; (s, 6� k$ q„dt r p9I0C0W_q A*4,- a'6.0664d S OP mit c��es, <br />Signature: o^V Date: Z " <br />(Four response to any of tete above inquiries may be continued on the back of this foarM 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 hm+e access to its programs, <br />,Facilities and employnient Mthoilt regard for race, creed, color, sex, age, national 011gin or handicap. <br />