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L <br />APPLICATION FOR ADVISORY GROUPS <br />Troup Applied For: <br />Second Choice (if any): <br />Ful Name (print or type): <br />Address�1'7 tLilL \ n� �w 55// z <br />Years At This Address:Years You Have Lived Inn Mounds View: <br />a rs tim0 `S �Ls5. .0 <br />Work or Other: <br />Telephone: Home:zy 3 Z ZSG <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />rs. O !B. a Goci 1lWr, f"i n stc, Its PrL' <br />Skills and Ilnte��es�s a�syverba o[;J[ iv9rK �/[ week <br />Y5l -fn SKrr ; <br />MySel� <br />Employment, Occupation or Other<ULj tqc'"/I-, aY�c� o It ¢�}Jdei <br />Pi03r.AmCacrd;natrr �'ar• -ke <br />` /�rt�Cics5.2 Cp[�rdi natf. 21l 5a4ety alass<tstic,-nliV nh v[r a;s Tielri< <br />';n4a:tii�. as •, Coe/,dxit` (c-1 !al: ou-v-�=.`p� <br />SuCuaii'-cr`9�i7t;c <br />�pJnrnuntmoCd fCeep f <br />Ct ,-,f9' u,f,:.1 <br />!leall CCU roof LOIu ie /A <br />rear o rrcations: <br />Memoersn>.po, ��-`�•"r------ -- <br />TCasTma s E-a <br />,tldtro„al �1;voY'�.� <br />A6c- e�mne, I <br />teG',reva"c-1 /icr ra{-Jon <br />please State Your Reasons For Wanting To Serf j09nt`Tuis CommiYy- <br />dey_,>drrblc and have <br />,I7 ✓Jt Gin ir,« N. til. 1 tLrJ <, Y"T�` lJ°: [1C•rna i3t0' <br />Lenr.r s�Th� 2 t,!✓e , n. <br />he bove ay <br />Your response to anfotheramatermalsbwhichtyouewant the Council <br />and you may any <br />to consider <br />Signature 1 ^vim <br />7mt <br />olic that all <br />The City o Mounds View is coed to the policy <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 />