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fAPPLICATION FOR ADVISORY GROUPS <br />C <br />Group Applied Fors C _ Q <br />Second Choice (if any): <br />Full Name (print or type): I es S�Q Je J� <br />Address: ar614 rfT .411 4,Las ll <br />h I'IPIS A3,.� a <br />Years At This Address: Years You Havg Lived In Mounds View: <br />Yg. Li <br />C • f J uearS <br />Telephone• Home: 75M _ 6ApthE_ <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />9d *A)O QC-WVP�%7 Y � <br />� fn ar90vu" valley <br />p of j ent, Occupation or Other-EXPWience: <br />* 1 50033 s0dE repr6S1At *UV <br />Membershi s, Accomplishments Qr Other Qualifications: <br />please State Your Reasons For Wanting To Serva On This Committee: <br />I ar colcun4 `illCt� `AG 8cfVCU <br />rwi- our P4r �k n in twnd� Dieu i � 1n Milo LJ7Nt e A h2sy• <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 />Ito conbidoe. _. _._ <br />Signature �IG Jl�ly+nd� Date .5-25-YK <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, Lr handicap. <br />