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�HK �y 2001 16�06 FR ASD SUBOFFICE DCRA 7635726287 T O 9-651-4902276 P.01f02 <br />�` .�� :� <br />w�N41l.Ci _roseVi{�E.111T1.113 <br />ax�o ❑� Rosavtllc • �� �(V�` � aox•:�, • R,oscville \rIN 55113 <br />Phone: 651.4902206 . Fax 651.490.T276 <br />Application for Citizen Advisory Commission <br />Please check commission applying for: <br />X Ethics Commission <br />o Grass Lakes Water 1Vianagemeat Orgaaiz�tfon <br />o Human Rights Commission <br />o ParkandRecreationCommission <br />0 Planning Commission <br />0 PoGce Civil ServiceCommiission <br />o Community Task Force(name) <br />/ / / Student �(Na <br />Name: ��G�/'d �, 4-.q�1tc Se �h Applicant o Yes, Grade <br />Address: � 7�� ��,��h(`y�(' �tl�/1t1�.. <br />�tosev�le <br />City/State/Zip: e�� � J�S� ResideutY e a r s <br />�� <br />Telephone: (Home) �PJ� l ��p �i � �oi � 8Jr (Workl ��3� S 7� -��eG�,�_ <br />Ems.il:_�'G{�fc%e �GriQS�i l.i� /�G, 2� i l Fax: �%3 �� 7`oi-- (,��� <br />J <br />�f�1L��aC°Ti • 'T�1� 'L�iT��.n'��ii�''ii�IT.r�� <br />Civic and Volunteer Activities: (�'ast �d Present) <br />