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<br />MAY 06 2005 3:57PM WF STATE BANK L TRUST <br />05/05/05 THU 09:37 FAX 701 241 5728 CASS COUNTY COURTHOUSE <br /> <br />p.2 <br />Ig] DD2 <br /> <br />APPLICATION FOR BOARDS AND COMMISSIONS <br /> <br />Board or Commiuion lor which you ar~ applying: <br />Hcusi.nq Aut:hOri of Cass . <br /> <br />FOR OFFICE USE ONl Y <br />I"P~i""dT' ' <br /> <br /> <br />Doatl! <br /> <br />i <br /> <br />YOUR NAME ILa1t.i=irn.......iddlr) COUl\ty legislative [)inrict lIIumber <br />PM~r ..,Al'her, Carol Janice Cass 22 <br />Permanent Mailirlg Address City State z~ code <br />. 206 2nd St S PO Box 354 f":::I!R..c;(('ll tan N) 8012 <br />Prelent MlIiling Address (If ditrerent) City State Zip Code <br />Your Occl,/pa~iQn - Title . BusineuPhone No. Residence PJ,one No. <br />CIlst:tmer 8eIVice tive 701-282-4403 701 347 4826 <br />Em~a~ & Trust <br />Em~ff9'~ St elm Fargo State Zip Code <br /> II) 58078 <br /> <br />EDUCATION'AND GENERAL QUAUFICATIONS <br /> <br />lEVel NAME OFSCHOOL LOCATION No. Ynrs Did You Major Course(sl <br />Attended Graduate ;, otstudy . <br />Higl\5chool . Leonard High Schcp Leonard,m 4 Yes <br />College Valley: City state. 1 Valley City, b D .2+ Yes "',., . <br /> EDUCe <br />TradeJ8usineSllUJrrrespondence <br />M~mbership5 in west Fargo Qlanftr:ar of Cc:mnerce Ambassadors <br />Organizations <br />and Offices Held. <br />. <br />Indicate Dates Held <br />: I <br />vorun~er Activities Generations Ccrmecting - Pres.enl AnbassadaJ:s - PIesent <br />Indicate if Past or Present St: Peter's Lutheran Ctmrch - Present American Cancer <br /> Society - Past Martin.s IDt:heran C'hurch Council - Past <br /> . <br />Your Special Skills and <br />Qualifications' SEE~ <br /> <br />ticn <br /> <br />REFERENCES (list three persons, not related to you. whom you have known for. at least one year.) <br /> <br />NAME ADDRESS Years <br /> PHONE NO. Acquainted <br />Ben Sdlolten WeSt , R> 701-298-1500 Nbrk 12 <br />Archie Pilley West Fargo, NO 701-282-7706 Heme 12 <br />Patty Bahnenst:inql NO 701 298-1882 Werle. 10 <br /> <br />I certify that the bets contained in this application are trUE! and correct to the best of my knowledge. I authorize investiga- <br />tion of all statements contained herein and the references Ii~ted abov~ to give you any and all information concerning my <br />qualifications and any pertinent information they may have, personal or otherwise. and ,,~Ieasl' all pattIes (rom all liability <br />for any damages that may result from furnishing the same to you. <br /> <br />I Q I (am not) a t least eignlee" ~ 18) rears of age. <br /> <br />RET~OMPLETEO FORM TO: <br />Cals County Commi55ion <br />BOle Z806 <br />Fargo. ND 56108 <br /> <br />SIGNA TURE <br /> <br />~~ <br /> <br />. 9. ~d~k-J <br />. DATE . 'bh6 !t,5 <br /> <br />(Please attach a copy of your resume' ) <br /> <br />.~- ., ::.- (,'... <br />