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R: <br />Q P. <br />rj <br />APPLICATION FOR ADVISORY GROUPS C,-, C <br />Group Applied For. E <br />nrreu <br />�oan � � <br />Second Choice (if any): 1j% <br />Full Name (print or type): <br />72 <br />Address: <br />- <br />6�517 '5Avv-(Jnnd�. <br />a� <br />Years At This Address: 31 Years You [lave Lived In Mounds View: <br />Telephone: Home: <br />Work or Other: <br />_ <br />- ig4 o5Kl, <br />hnn0 <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: F„ rtad;, ( <br />.S i q , �oltHcs, uterewtl StN i's, C1n a <br />Jac ou4 dctr <br />Employment, Occupation or Other Experience: <br />Mhubbl0105;5E- CA fie, o�AIN PSpko-,, tclorke, mr <br />3h9 ea,^� bus hey dcJree �icn, 5+ 71,omas CoUry <br />Memberships, Accomplishments Or Other Qualifications: <br />115''56ed h1'rtbolo9tsi <br />Please State Your Reasons For Wanting To Serve On This Committee: <br />T- eonSidpr (A �raclic,� enoiranm+wlal(5t' ah� desire. 4o bz <br />aclio� ;n orn.�laH,c� Erer�� �oltey. Z loue +o bt acl:�oe Q4 <br />el.alle,tj;..j s1�a- on T I su <br />that z could„ bn, +o +6e . rp AN e <br />r <br />Ln 5 ea&I slCdsw ec er+lse, <br />Your response to any of the above ay be continued on the back <br />and you may attach any other materials which you want the Council <br />to consider. <br />Signature , Date �Pt5 <br />The City of Mounds View i committed to the policy that all <br />persons shall have equal access to its programs, facilities, and <br />employment without :�gard to race, creed, color, sex, age, <br />national origin, or handicap. <br />Allaclrel a cyrf o� Lt re�u(IN k <br />} <br />"4nk) ion Dour �OnSit�Frc.11Jr1, <br />-or •u'rAvt- elanAoc,.6n, <br />