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<br /> <br />YOUR NAME (Last, First, Middle) <br />J40ettnPl Sk.i f/1. <br />Mailing Address <br />7tJ5 - I 'Sib A~. S. <br />Your Occupation - Title <br />Arch;~cIvrA.1 Pe6i <br /> <br />Employer Name <br /> <br /> <br />$cl~ <br /> <br />'Ro. ~ J~ <br /> <br />RECEIVED <br />DECI,__420071 <br /> <br />CASS COUNTY COMMISSION <br /> <br />County <br /> <br />Legislative District Number <br />Z,.'2- <br /> <br />State Zip Code <br /> <br />NP '580...7 <br />Residence Phone Number <br /> <br />~a$~ <br /> <br />City <br /> <br />1fl!mG<..- <br />Business Phone Number <br /> <br /> <br />701 20:;2. ('7""" <br /> <br />701 Z52. (,?ftt, <br /> <br />';W()$h1p - ~ U>~ <br />City <br /> <br />State <br />ND <br /> <br />Zip Code <br />!:1Bt>'/7 <br /> <br />~ <br /> <br />EDUCATION AND GENERAL QUALIFICATIONS <br /> <br />LEVEL NAME OF SCHOOL LOCATION No. Years Did You Major Course(s) <br /> Attended Graduate? of Study <br />High School /,...;nGDI" I-I-~ ~N I ~OL'1-ml".~ '/.'$ l404l. <br />College f~D. NP C, '1e~ ~ k-c.n. <br /> "'~ <br />Trade/Business/Correspondence <br /> <br /> <br />I certify that the facts contained in this application are true and correct to the best of my knowledge. I authorize investigation of all statements contained <br />herein and the references listed above to give you any and all information concerning my qualifications and any pertinent information they may have. <br />personal or otherwise. and release all parties from all liability for any damages that may result from furnishing the same to you. <br /> <br />__~.. /h ~~--- <br /> <br />, <br /> <br />12-~-CJ7 <br /> <br />Memberships in Organizations <br />and Offices Held <br /> <br />Indicate Dates Held <br /> <br />Volunteer Activities <br /> <br />Indicate if Past or Present <br /> <br />Your Special Skills and <br />Qualifications <br /> <br />L.i~ 01e1d <br />f...{)Y; Jt?h~ <br />ROlU-- t~en <br /> <br />RETURN COMPLETED FORM TO: <br />Cass County Commission <br />PO Box 2806 <br />Fargo NO 58108-2806 <br /> <br />Ca~ c;lJtmfy '7/>WfIfiJip O;';IcU'f> ~c.ia.'H"" - c.cJYyen+ Mmlbe..- <br />NC(#) ~~ -roW~ip O#'ur-s ~..la:H/)f1 -- c.o;,.-en+ fYI'lmW"" <br /> <br />Pa~- ~lil. ~+IIJ/He()fy),tWlp) VIJI~ 8"~13q~'-~~1 <br />a,t'~ta6 ,.,.v~~()f'Y} ~ YVtlU"- ntYth, t,A\,ka kJAt1 Pta'1 t>f GN"j~ <br />p...e6enl- - A FDr ~; ~ lIo101\fu.rJ m()tfl ,N()f"rrw1 ~ ~ <br />M\.f 6kill~: WorK Wt-II WI:'+' a fea",} 86td /f~ ()nd J ~e ~ <br />~ of ~mmt)ni+tt aWayt,r}e~ ~ tIlVblvemenf: <br />Qoalj+:~;M6: R4'!1t' .fnm tk +t:>nna.1 ecJck:at-itJf) In "P/a.nfl;~ Ar.d <br />f)t)/elopi (eA Aftlt. ..fo holdi 4 ~vernmenhtl i+:lm iw <br />~(vj~. <br /> <br /> <br />ou have known for at least one ear <br />PHONE NO. <br /> <br />Years <br />A uainted <br /> <br />Wlldena J-1 i (\Y\. <br />h 0 N:D. <br />H-br~, N.D. <br /> <br />Z1B - ~ ~/ -I&.fz.€> <br />701 - Z '7'" 1'2.t,7 <br />70 I.- 1f3 - ~~-z.,. <br /> <br />2':5 ~ <br />I ~ ettt"5 <br />1 '1~ <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />(Please attach a copy of your resume') <br />