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City of Mounds View <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />(763)717-4000 <br />plication for Advisory Boards sand Commissions <br />Group Applied for: /1Sr Y 1 �G (l �.C1 �L°nn (�Y! ,� ,_ U l� 5 ld ��� 7✓} 1 I SS lC�'� l <br />Full Marne ('lease l lint): <br />Rome Rhone: f Z 945 - Q tla3 workphone: -7613- <br />Address: <br />613-rAddress 2�.— <br />Yeaxs at this address: 2— _ ''ears you have lived in Mounds View: 3 <br />E-mail Address: Rte:, � �G GoPrCaSS ,hlt� <br />gualifications You Want to Have the Manor and 01Y Council Consider: <br />Skills and ltexests: f ,e c� <br />1 -,As horn &,"Cn t ✓`4)S nn1 g �idG�Q r2�rL' �7 [l�itjnV i74rra �tstc� V&4 - <br />6L <br />$!e� h itif Cav1el A1,bP�u t• LLa 7 s1'�rhe� ntn�d!d[�r %aGLit r. / &t'v dV wn- I ZZ t, -k <br />�"� Yr�vft- Pt1tt� (AN� qf!"/"n9•f� �h�'o Gt. .� Lmtc,.r •��cQJ daub <br />Emloyrnent, Qr�ccupatic►n or Ut�rh^ex Beriancel: r"l�y! i� ��pw« �s 6 <br />P,a � al�+s (rrt�r'Nct�+" t Ward 1,4,11 %` e .5c70 cLor�pan�e n �Q i � <br />c4oaii4'+ of RMk fit QV e s,,44,0 ---e G1S3n�yr G�rcld`4j fa 4'j/�iNa y+1oS2 <br />C+(4')� oo,,��S, Pn>v).'r$ !fir a `r <br />My�embersliips, ,A,ccomplisht/eats or Other Q alaicatlons:( <br />T 1tsi,1 Q BS /it/G�G"�i I GR11QlL��t�f t�1 fYhM+ 5nk7hk%q%C �h1+4 2'57+" <br />.T �,tos se -v4 !lt <br />Please state your reason for wanting to serve with this group: I64 <br />, 1ec,5 afl� C-Wil-^6'ge. M.,kmJs a{�`rEa7,ta+ �hrz - <br />jrt iASd� C iF Gr u±, <br />Cp + dSsd� lne.-dLP , 1Maiis� �arl�s ,�Nd pvo�ratw+a �'�� Me..,, s �1f dig s^ <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 any other material that you would want the Mayor and Council to consider.) <br />The City nfMounds View is committed to the policy that all persons shall have access to its programs, <br />,Facilities and emploAjent without regard for race, creed, color, sex, age, national origin or handicap. <br />