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IIdtyof <br /> 1,BMGHTON <br /> the city that works ibr you <br /> Advisory Commission Application <br /> Date 2 - 9— 12 <br /> General Information <br /> Name DA N\6-eg, <br /> Last First M.I. <br /> Address \ 53 2- 16 ' • I C v3 <br /> City, State ZIP IQ } i J C-�#{�fJ 1�. `�`5 i Z-- <br /> Phone 6 51 - 6 3( — 4-774o 76,3- Z3Z- 3233 <br /> Home Business Cell <br /> Email Address Sk.eV?Cy.l&y v 1 if-AA0--Z COtM <br /> Commission/Task Force <br /> Public Safety Commission Economic Development Commission <br /> XPlanning Commission _ Civil Service Commission <br /> Park, Recreation&Environmental Comm. <br /> Availability (Check all Preference <br /> After work, early evening K Evening, after supper Early morning <br /> List specific days or times you are not available <br /> Personal Information <br /> List any related work/education experience: <br /> cU P�RI= rr' Nt t✓NA Raz_.of Pt LoMAt55i o1J <br /> cc=tilO D u tG- Co fSTIZAc ) <br />