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<br />CASSCOUNTYGOVERNMENT <br />APPLICATION FOR BOARDS AND COMMISSIONS <br /> <br />RECEIVED <br />AU6118200B <br /> <br />Board of Commission for which you are applying: <br />l,A)~d CoN' 1"0 I g () ~ ~ d .... SOl.'\. ftV)a.sT <br /> <br />CASS COUNTY COMMISSION <br /> <br />YOUR NAME (Last, First, Middle) <br />~ JG.N/VtJ....-v C.A j-t?N ~, <br />Mailing Address <br />G 0 '6 ItN N ST <br />Your Occupation - Title . ll'l.l~T'rl <br />t<.9. T: I--~J JVJ ,L I b ,""l Se-I-tOl?J tW) <br /> <br />County <br />( ft-S <; <br />City <br />WJLsT FA. Y<? 0 <br />Business Phone Number <br /> <br />Legislative District Number <br /> <br />Ii ~ ,.. "v CJ v J I r-cc I ,-...J l <br />State Zip Code <br /> <br />ND <br /> <br />S-807g <br /> <br />.3 .5 G - "d-/ ;:)..0 <br /> <br />Residence Phone Number <br /> <br />;;L8;J-280G <br /> <br />Employer Name <br /> <br />WSL5/J PiA v t> 5e"-c-o / <br />Employer Address <br /> <br /> <br />T" ^- AI S j!.?/J'r-.t- ;.;f / I-J <br />City <br />/;J'1l s:t Pa v R (J <br /> <br />State <br /> <br />Zip Code <br /> <br />NT> <br /> <br />no <br /> <br />EDUCATION AND GENERAL QUALIFICATIONS <br />LEVEL NAME OF SCHOOL LOCATION No, Years Did You Major Course(s) <br /> Attended Graduate? of Stud <br />High School /VIe V f IL~ ND GJ2?J'Qr4/ <br />U/r <br />College <br />Trade/Business/Correspondence tit t'f 0 ~ It-PS <br /> <br /> <br /> <br /> <br />Memberships in Organizations 141-1 v.Q.T5 ~tJ5.1 7 <br />and Offices Held <br />Indicate Dates Held It- JI.-l..Jl v- I, A-.,J ~/PA.;l <br />Volunteer Activities f<lld 12.'v-ri.j, kh.... ~.tl >.f C L..... /; , <br />Indicate if Past or Present <br />Your Special Skills and I:-h I-- ~..... T'i'- tl I AJ I IV r <br />Qualifications <br /> <br /> <br />ear <br /> <br />Years <br />Ac uainted <br /> <br />G tZA-d <br />~ lA. ",t, <, <br /> <br />4eiN <br />V ~ N~k!. <br /> <br /> <br />va. ,>'Tp.t ,rt ~ _ <br />~ /t7V ~ s7'. ?- ~2 - -SD '-I <br /> <br />A/b <br /> <br />;) 3;)- - 6 <br /> <br /> <br />IL .,-J <br />/ [, ~"..J <br />IS- ~. <br /> <br />L U.Q.......'N <br /> <br />~ <br />II'W- , "-4. , ;)....BI - q I If s- <br /> <br />RETURN COMPLETED FORM TO: <br />Cass County Commission <br />PO Box 2806 <br />Fargo ND 58108-2806 <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 />~~? <br />g- J3-cPg <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />(Please attach a copy of your resume') <br />