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APPLICATION FOR ADVISORY GROUPS <br />Croup Applied For: <br />Second Choice (if any): <br />Full Name (print or type <br />Address: <br />xcp <br />LIiUCc.0.�E- �� <br />Years At This Address: <br />15 4cr\;5 <br />Years <br />You Have Lived In Mounds View: <br />!i5 vent" --- <br />Telephone: Homer <br />t`sb'�l <br />:J9 <br />work or Other: <br />'i84--400 6 <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills anti Interests: <br />C X c, <br />�K - <br />Employment, Occupation or Other Experience: <br />�:u te6`..'. C'v1q 1,�40.fs <br />V` <br />Membberships, Accomplishments•Or Other Qu.9lifications: <br />GAS. <br />\ 1. C pQ <br />Cc �S `�C• V`1J� 1-1..y(c1��V\C.\\\: :'1 �l � J`\ 1�:;�. Vl\`ji'- Y\CJ.� -`c\ \3 <br />Please State Your Reasons For Wanting 'TO Serve On This Committee: <br />�C:� \�'oC L S\Cc;`.^ � t�`.,_c.�- \c,o•c�,no ��C 'wr;\�1 <br />Your response 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. <br />Signature 1�' : A� `� ,\\'M.\. ;y'f • Date_<�`^ <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 />